Conway Psychiatric Clinic, PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C-8236 Issued in AR

Legal business name

CONWAY PSYCHIATRIC CLINIC, PLLC

Practice address

5330 Plantation CV
Conway, AR 72034-8586

Phone

(501) 472-7697

NPI assigned

Jan 20, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Raymond Harlech Clark, M.D.NPI 1750483699

Title

Doctor

Phone

(501) 472-7697

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raymond H Clark, MD

  • Psychiatry Physician
  • Conway, AR
  • NPI 1750483699
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1972808145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10705",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720340012",
            "telephone_number": "501-472-7697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 PLANTATION CV",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348586",
            "telephone_number": "501-472-7697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY PSYCHIATRIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-20",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "HARLECH",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "501-472-7697",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "C-8236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129952001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Conway Physical Therapy Clinic, PA
• Conway Psychological Assessment Center
• Conway Public Schools
• Conway Public Schools #01
• Conway Pulmonology Clinic, PA
• Conway Radiology Consultants, LLC

• Psychiatry Physician in Conway, AR
• Providers in Conway, AR by specialty
• Psychiatry Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.