Provider Demographics
NPI:1033180807
Name:THOMAS W. CONWAY
Entity Type:Organization
Organization Name:THOMAS W. CONWAY
Other - Org Name:PRIMARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-623-0640
Mailing Address - Street 1:434 4TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3746
Mailing Address - Country:US
Mailing Address - Phone:423-623-0640
Mailing Address - Fax:423-623-7615
Practice Address - Street 1:434 4TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3746
Practice Address - Country:US
Practice Address - Phone:423-623-0640
Practice Address - Fax:423-623-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3718054OtherMEDICARE GROUP ID
TN3718054Medicaid
TN3718054Medicare PIN
TNA98090Medicare UPIN
TN3718054Medicaid