Organization
CONWAY HOSPITAL, INC.
Active
Other names
CMC Primary Care Myrtle Trace, CPG Internal Medicine Myrtle Trace
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN ARTIOLI (CREDENTIALING SPECIALIST)
(843) 234-6946
Entity
Organization
Contact information
Practice address
8004 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 234-8939
(843) 234-8959
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PATIENT ACCOUNTING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4505
—
SC
Enumeration date
07/21/2010
Last updated
09/27/2022
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