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Organization
CONWAY HOSPITAL, INC.
Active
Organization
CONWAY HOSPITAL, INC.
Active
Other names
CMC Primary Care Grande Dunes
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
1100 62ND AVE N, STE A, MYRTLE BEACH, SC 29572-7202
(843) 839-0957
(843) 839-0758
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PG2250
—
SC
Enumeration date
06/21/2024
Last updated
09/05/2024
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