Provider Demographics
NPI:1437505955
Name:CONWAY, STEPHEN PAUL (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:CONWAY
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 8TH AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4140
Mailing Address - Country:US
Mailing Address - Phone:817-344-7948
Mailing Address - Fax:866-591-7596
Practice Address - Street 1:1307 8TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4140
Practice Address - Country:US
Practice Address - Phone:817-344-7948
Practice Address - Fax:866-591-7596
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015726171M00000X
TX051726253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator