Healthcare Provider Details

I. General information

NPI: 1730601451
Provider Name (Legal Business Name): CONWAY REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WESTERN AVE STE 302
CONWAY AR
72034-4981
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-6649
  • Fax: 501-328-5518
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. WILLIAM PACK
Title or Position: CFO
Credential:
Phone: 501-450-2112