Conway Hospital, Inc.
Organization Active NPI Pediatrics Physician · Conway, SC
NPI 1558835355 · NPPES record last updated Jul 13, 2021
Key facts
- NPI
- 1558835355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- CONWAY HOSPITAL, INC.
- Practice address
- 124 Professional Park Drive, Ste a
Conway, SC 29526-9260 - Phone
- (843) 234-8788
- Fax
- (843) 234-8787
- NPI assigned
- Jan 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Mary Ellen Artioli
- Title
- Credentialing Specialist
- Phone
- (843) 234-6946
Other NPIs on the same Medicare enrollment 40
Corporate family (same tax ID) 33
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031201000111 | SC | Part B Supplier - Clinic/Group Practice | 7113839606 |
Receives reassigned benefits from 148 practitioners 41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Conway, SC; Surfside Beach, SC; Myrtle Beach, SC; Murrells Inlet, SC; Little River, SC; Florence, SC |
National Provider Directory
- Tax ID family
- Conway Hospital Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Medical Physician Assistant |
363AM0700X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
124 Professional Park Drive, Ste a
Conway, SC 29526-9260
Mailing address
300 Singleton Ridge Rd
Attn: Patient Accounting
Conway, SC 29526-9142
Phone (843) 234-6946
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP8821 | Medicaid | SC |
Other names
- CMC Pediatrics Conway
- CONWAY HOSPITAL COMMUNITY SERVICES
Other providers in Conway, SC
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
- Conway Hospital, Inc.
All providers in Conway, SC · Pediatrics Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.