Organization
CONWAY HOSPITAL, INC.
Active
Other names
CMC Primary Care Coastal Carolina University
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
251 UNIVERSITY BLVD, STE A, CONWAY, SC 29526-8834
(843) 347-0524
(843) 347-0655
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PG2280
—
SC
Enumeration date
06/18/2024
Last updated
08/15/2024
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