Basic Information
| Provider Information | |||||||||
| NPI: | 1568423820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONWAY ANESTHESIOLOGY CONSULTANTS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11619 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720340028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013276665 | ||||||||
| FaxNumber: | 5017300289 | ||||||||
| Practice Location | |||||||||
| Address1: | 2302 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720344967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013276665 | ||||||||
| FaxNumber: | 5017300289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANGEL | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5013276665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 142505002 | 05 | AR | MEDICAID |