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Organization
CONWAY HOSPITAL, INC.
Active
Organization
CONWAY HOSPITAL, INC.
Active
Other names
CMC Primary Care Creel Street, CPG INTERNAL MEDICINE CREEL STREET, CMC PRIMARY CARE-CREEL STREET
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
1301 CREEL ST, CONWAY, SC 29527-5018
(843) 248-4414
(843) 248-3781
Mailing address
300 SINGLETON RIDGE RD, ATTN: PATIENT ACCOUNTING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4505
—
SC
Enumeration date
09/27/2007
Last updated
09/27/2022
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