MEDICARE: CONWAY HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363AM0700X	Medical Physician Assistant
2	363LF0000X	Family Nurse Practitioner
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427892728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONWAY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTENTION PNS CREDENTIALING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:	843-234-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 62ND AVE N
Second Line	:	STE A
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-7202
Country	:	US
Telephone Number	:	843-839-0957
Fax Number	:	843-839-0758

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MARY ELLEN ARTIOLI
Credential	:
Telephone Number	:	843-234-6946

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	09/05/2024

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