Provider Demographics
NPI:1518133099
Name:CONWAY PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:CONWAY PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. BOOKKEEPER/MEDICAID BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-6634
Mailing Address - Street 1:1925 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3823
Mailing Address - Country:US
Mailing Address - Phone:501-450-4862
Mailing Address - Fax:
Practice Address - Street 1:1925 LEE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3823
Practice Address - Country:US
Practice Address - Phone:501-450-4862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116042743Medicaid