Provider Demographics
NPI:1790886463
Name:CONWAY DIGESTIVE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CONWAY DIGESTIVE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MOIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-932-0282
Mailing Address - Street 1:2200 ADA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4985
Mailing Address - Country:US
Mailing Address - Phone:501-932-0282
Mailing Address - Fax:501-932-0284
Practice Address - Street 1:2200 ADA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4985
Practice Address - Country:US
Practice Address - Phone:501-932-0282
Practice Address - Fax:501-932-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1456207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155226002Medicaid
AR155226002Medicaid