Organization
SURGICAL ASSOCIATES OF CONWAY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THADDEUS MICHAEL STANTON M.D. (PHYSICIAN)
(501) 327-4828
Entity
Organization
Contact information
Practice address
525 WESTERN AVE, SUITE 203, CONWAY, AR 72034-4967
(501) 327-4828
(501) 327-6899
Mailing address
525 WESTERN AVE, SUITE 203, CONWAY, AR 72034-4967
(501) 327-4828
(501) 327-6899
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MC1888
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MC1888
STATE MED BOARD LISCENSE
AR
Enumeration date
05/08/2007
Last updated
08/22/2020
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