CONWAY CHILDRENS CLINIC PA CORP NPI 1003189606

NPI Information

CONWAY CHILDRENS CLINIC PA CORP is a rural health clinic center in Greenbrier, AR. CONWAY CHILDRENS CLINIC PA CORP NPI is 1003189606. The provider is registered as an organization entity type.
The provider Is Doing Business As Greenbrier Childrens Clinic.

The provider's business location address is:

10 LOIS LANE
GREENBRIER, AR
ZIP 72058
Phone: (501) 679-6796

The provider's authorized official is Michael Connaughton .
The authorized official title is Owner/md and has the following contact phone number (501) 327-6000.

The CLIA number assigned to this NPI record is 04D0466258 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/14/2012 and was last updated on 2/14/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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