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Organization
CONWAY HOSPITAL, INC.
Active
Organization
CONWAY HOSPITAL, INC.
Active
Other names
CMC Pediatrics Conway, CONWAY HOSPITAL COMMUNITY SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
124 PROFESSIONAL PARK DRIVE, STE A, CONWAY, SC 29526-9260
(843) 234-8788
(843) 234-8787
Mailing address
300 SINGLETON RIDGE RD, ATTN: PATIENT ACCOUNTING, CONWAY, SC 29526-9142
(843) 234-6946
(843) 234-6990
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NULL
208000000X
Pediatrics Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
NULL
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP8821
—
SC
Enumeration date
01/15/2019
Last updated
07/13/2021
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