Provider Demographics
NPI:1568647287
Name:E.A.CONWAY MEDICAL STAFF GROUP
Entity type:Organization
Organization Name:E.A.CONWAY MEDICAL STAFF GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:ARYON
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-330-7858
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-8005
Mailing Address - Country:US
Mailing Address - Phone:318-330-7858
Mailing Address - Fax:318-330-7719
Practice Address - Street 1:4864 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-330-7858
Practice Address - Fax:318-330-7719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E.A.CONWAY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF8393OtherBLUECROSS BLUE SHIELD