1427202639 NPI number — CONWAY EMERGENCY PHYSICIANS, P.A.

Table of content: (NPI 1427202639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427202639 NPI number — CONWAY EMERGENCY PHYSICIANS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONWAY EMERGENCY PHYSICIANS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOUND CARE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427202639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72033-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-513-5793
Provider Business Mailing Address Fax Number:
501-513-5870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 ADA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-513-5444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STONE
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-513-5793

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  C5964 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: E0837 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: E3733 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: C5240 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00089411-CP87 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 10035643 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 111533001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3920046 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130948001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930055480 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 930104614 . This is a "MEICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103074001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150518001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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