Provider Demographics
NPI:1487695771
Name:CONWAY RADIOLOGY CONSULTANTS, LLC
Entity type:Organization
Organization Name:CONWAY RADIOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-329-3272
Mailing Address - Street 1:555 CLUB LANE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3681
Mailing Address - Country:US
Mailing Address - Phone:501-329-3272
Mailing Address - Fax:501-329-3273
Practice Address - Street 1:555 CLUB LANE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3681
Practice Address - Country:US
Practice Address - Phone:501-329-3272
Practice Address - Fax:501-329-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC24482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F513Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER