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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