1861725871 NPI number — CONWAY EMERGENCY PHYSICIANS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861725871 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:
Provider Other Organization Name Type Code:
6
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:
1861725871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 757
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:
72033-0757
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:
501-450-2216
Provider Enumeration Date:
09/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEAR
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
501-513-5793

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C5964 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 177833002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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