Organization
CONWAY CHILDRENS CLINIC PA CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A CONNAUGHTON MD (PRESIDENT)
(501) 327-6000
Entity
Organization
Contact information
Practice address
2505 COLLEGE AVE, CONWAY, AR 72034
(501) 327-6000
(501) 450-7559
Mailing address
2505 COLLEGE AVE, CONWAY, AR 72034
(501) 327-6000
(501) 450-7559
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115903002
—
AR
01
—
57800
BLUE CROSS
AR
Enumeration date
03/29/2006
Last updated
02/07/2011
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