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CONWAY PEDIATRICSPA NPI 1518986637


NPI Information

NPI: 1518986637
Provider Name: CONWAY PEDIATRICS,PA
Classification: Legal Medicine - 173000000X
Entity Type: Organization

CLIA Number: 42D0692256

Address:
907 BELL ST
CONWAY, SC
ZIP 29526
Phone: (843) 248-2727
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CONWAY PEDIATRICS,PA is a legal medicine in Conway, SC. The provider is the specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. CONWAY PEDIATRICS,PA NPI is 1518986637. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

907 BELL ST
CONWAY, SC
ZIP 29526-113
Phone: (843) 248-2727
Fax: (843) 248-5107

The provider's authorized official is Thomas Petrusick .
The authorized official title is Doctor and has the following contact phone number (843) 248-2727.

The CLIA number assigned to this NPI record is 42D0692256 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/19/2006 and was last updated on 2/20/2014.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1173000000XLegal Medicine4548SOUTH CAROLINAYes

Other Identifiers

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

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1RHC063MEDICAIDSOUTH CAROLINA
2C60512MEDICARE UPINSOUTH CAROLINA
3=========OTHERSOUTH CAROLINATAX ID #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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