Provider Demographics
NPI:1427202639
Name:CONWAY EMERGENCY PHYSICIANS, P.A.
Entity Type:Organization
Organization Name:CONWAY EMERGENCY PHYSICIANS, P.A.
Other - Org Name:WOUND CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-513-5793
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0727
Mailing Address - Country:US
Mailing Address - Phone:501-513-5793
Mailing Address - Fax:501-513-5870
Practice Address - Street 1:2200 ADA AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4985
Practice Address - Country:US
Practice Address - Phone:501-513-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5964208D00000X
ARE0837208D00000X
ARE3733208D00000X
ARC5240208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00089411-CP87OtherMEDICARE RAILROAD
AR10035643OtherMEDICARE RAILROAD
AR111533001Medicaid
3920046OtherUNITED HEALTH CARE
AR130948001Medicaid
AR930055480OtherMEDICARE RAILROAD
930104614OtherMEICARE RAILROAD
AR103074001Medicaid
AR150518001Medicaid
AR130948001Medicaid
AR10035643OtherMEDICARE RAILROAD
3920046OtherUNITED HEALTH CARE
ARF81482Medicare UPIN
ARC68245Medicare UPIN
AR103074001Medicaid
ARP00089411-CP87OtherMEDICARE RAILROAD
AR930055480OtherMEDICARE RAILROAD