Provider Demographics
NPI:1962617241
Name:CONWAY HEMATOLOGY ONCOLOGY
Entity type:Organization
Organization Name:CONWAY HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-2995
Mailing Address - Street 1:350 SALEM RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-327-9995
Mailing Address - Fax:
Practice Address - Street 1:350 SALEM RD STE 4
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6133
Practice Address - Country:US
Practice Address - Phone:501-327-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123637001Medicaid
AR123637001Medicaid
AR5F654Medicare PIN