Provider Demographics
NPI:1871736629
Name:CONWAY NEUROLOGY SPECIALTIES, PA
Entity type:Organization
Organization Name:CONWAY NEUROLOGY SPECIALTIES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-328-8405
Mailing Address - Street 1:5004 POOL ROAD
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4595
Mailing Address - Country:US
Mailing Address - Phone:903-548-6440
Mailing Address - Fax:903-548-6441
Practice Address - Street 1:5004 POOL ROAD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4595
Practice Address - Country:US
Practice Address - Phone:903-548-6440
Practice Address - Fax:903-548-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM79192084N0400X
OK256942084N0400X
AL269312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI47030Medicare UPIN