MEDICARE: CONWAY REGIONAL MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265421861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONWAY REGIONAL MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 9662
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72033-9662
Country	:	US
Telephone Number	:	501-852-1363
Fax Number	:	501-852-1364

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S STE 201
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-6678
Country	:	US
Telephone Number	:	501-745-4914
Fax Number	:	501-745-6374

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MATTHEW TROUP
Credential	:
Telephone Number	:	501-450-2111

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/31/2025

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