MEDICARE: MR. STEPHEN PAUL CONWAY ADMINISTRATOR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	015726	TX
2	253Z00000X	In Home Supportive Care Agency	051726	TX

General Provider Information

NPI Number	:	1437505955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN PAUL CONWAY ADMINISTRATOR

Provider Business Mailing Address
First Line	:	1307 8TH AVE STE 311
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4140
Country	:	US
Telephone Number	:	817-344-7948
Fax Number	:	866-591-7596

Provider Business Practice Location Address
First Line	:	1307 8TH AVE STE 311
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4140
Country	:	US
Telephone Number	:	817-344-7948
Fax Number	:	866-591-7596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	02/19/2024

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