| Conway Psychiatric Center | |
|
680 Hogan Ln Conway AR 72034-8131 | |
| (501) 505-8900 | |
| (501) 505-8902 |
| Full Name | Conway Psychiatric Center |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 680 Hogan Ln, Conway, Arkansas |
| Authorized Official Name and Position | Jackie Coombe-moore (PRESIDENT) |
| Authorized Official Contact | 5015058900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Conway Psychiatric Center 680 Hogan Ln Conway AR 72034-8131 Ph: (501) 505-8900 | Conway Psychiatric Center 680 Hogan Ln Conway AR 72034-8131 Ph: (501) 505-8900 |
| NPI Number | 1841513223 |
|---|---|
| Provider Enumeration Date | 03/12/2010 |
| Last Update Date | 03/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841513223 | NPI | - | NPPES |
| 11547000000 | Other | AR | QCA |
| 55779 | Other | AR | MEDICARE PTAN |
| 122013001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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