# PCMC-CONWAY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871755421
- **Authorized official:** DR. JOHN PAUL WORNOCK (PRESIDENT)
- **Authorized official phone:** (501) 279-9000

## Contact information

- **Practice address:** 1014 HARKRIDER ST, SUITE B, CONWAY, AR 72032-4404
- **Practice address phone:** (501) 327-7100
- **Practice address fax:** (501) 327-7121
- **Mailing address:** 1014 HARKRIDER ST, SUITE B, CONWAY, AR 72032-4404
- **Mailing address phone:** (501) 327-7100
- **Mailing address fax:** (501) 327-7121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E1057 | AR | Yes |

## Other

- **Enumeration date:** 06/25/2008
- **Last updated:** 06/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1386614097 | — | AR |