Healthcare Provider Details

I. General information

NPI: 1396913976
Provider Name (Legal Business Name): CONWAY REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 COLLEGE AVE STE 100
CONWAY AR
72034-6297
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-5385
  • Fax: 501-513-5257
Mailing address:
  • Phone: 501-745-4914
  • Fax: 501-745-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2657
License Number StateAR

VIII. Authorized Official

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