Provider Demographics
NPI:1568423820
Name:CONWAY ANESTHESIOLOGY CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:CONWAY ANESTHESIOLOGY CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-6665
Mailing Address - Street 1:PO BOX 11619
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0028
Mailing Address - Country:US
Mailing Address - Phone:501-327-6665
Mailing Address - Fax:501-730-0289
Practice Address - Street 1:2302 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-327-6665
Practice Address - Fax:501-730-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142505002Medicaid
AR5C457Medicare ID - Type Unspecified