Provider Demographics
NPI: | 1316221500 |
---|---|
Name: | CONWAY HOSPITAL, INC. |
Entity Type: | Organization |
Organization Name: | CONWAY HOSPITAL, INC. |
Other - Org Name: | CMC ORTHOPAEDICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CREDENTIALING SPECIALIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY ELLEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ARTIOLI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 843-234-6946 |
Mailing Address - Street 1: | 300 SINGLETON RIDGE ROAD |
Mailing Address - Street 2: | ATTENTION PATIENT ACCOUNTING |
Mailing Address - City: | CONWAY |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29526-9142 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-234-6946 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8004 MYRTLE TRACE DR STE 200 |
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: | 843-347-8041 |
Practice Address - Fax: | 843-347-8042 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-10-05 |
Last Update Date: | 2022-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | GP9812 | Medicaid | |
SC | PG0459 | Medicaid | |
SC | GP4505 | Medicaid |