Provider Demographics
NPI:1821335068
Name:CONWAY HOSPITAL COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CONWAY HOSPITAL COMMUNITY SERVICES
Other - Org Name:CPG FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-234-6946
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:51 11TH AVE
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3249
Practice Address - Country:US
Practice Address - Phone:843-358-3700
Practice Address - Fax:843-358-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6275Medicaid
SCRHC224Medicaid