NPIMap

Organization Active NPI

PCMC-Conway PA

  • Family Medicine Physician
  • Conway, AR
National Provider Identifier
1871755421
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E1057 Issued in AR
Legal business name
PCMC-CONWAY PA
Practice address
1014 Harkrider St
Suite B
Conway, AR 72032-4404
Phone
(501) 327-7100
Fax
(501) 327-7121
NPI assigned
Jun 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Paul Wornock
Title
President
Phone
(501) 279-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X E1057 AR Primary

Addresses

Primary practice location

1014 Harkrider St
Suite B
Conway, AR 72032-4404

Mailing address

1014 Harkrider St
Suite B
Conway, AR 72032-4404
Phone (501) 327-7100

Other identifiers 1

IdentifierTypeStateIssuer
1386614097MedicaidAR

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1871755421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 HARKRIDER ST",
            "address_2": "SUITE B",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324404",
            "telephone_number": "501-327-7100",
            "fax_number": "501-327-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 HARKRIDER ST",
            "address_2": "SUITE B",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324404",
            "telephone_number": "501-327-7100",
            "fax_number": "501-327-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCMC-CONWAY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "WORNOCK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-279-9000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E1057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386614097",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.