Provider Demographics
NPI:1831302512
Name:SURGICAL ASSOCIATES OF CONWAY PLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF CONWAY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-4828
Mailing Address - Street 1:525 WESTERN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4967
Mailing Address - Country:US
Mailing Address - Phone:501-327-4828
Mailing Address - Fax:501-327-6899
Practice Address - Street 1:525 WESTERN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-327-4828
Practice Address - Fax:501-327-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC1888OtherSTATE MED BOARD LISCENSE