Provider Demographics
NPI:1043632805
Name:CONWAY HOSPITAL COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CONWAY HOSPITAL COMMUNITY SERVICES
Other - Org Name:CPG WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FISCAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-234-5139
Mailing Address - Street 1:PO BOX 50760
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0013
Mailing Address - Country:US
Mailing Address - Phone:843-234-6827
Mailing Address - Fax:
Practice Address - Street 1:8004 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8945
Practice Address - Country:US
Practice Address - Phone:843-347-7216
Practice Address - Fax:843-347-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty