Provider Demographics
NPI:1346601614
Name:CONWAY HEMATOLOGY ONCOLOGY PLLC
Entity Type:Organization
Organization Name:CONWAY HEMATOLOGY ONCOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-327-2995
Mailing Address - Street 1:350 SALEM RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6166
Mailing Address - Country:US
Mailing Address - Phone:501-327-2995
Mailing Address - Fax:501-327-2583
Practice Address - Street 1:350 SALEM RD STE 4
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6166
Practice Address - Country:US
Practice Address - Phone:501-327-2995
Practice Address - Fax:501-327-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC84941835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123637001Medicaid
5F654Medicare PIN
ARF63550Medicare UPIN