Healthcare Provider Details

I. General information

NPI: 1174092217
Provider Name (Legal Business Name): CONWAY REGIONAL MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CLUB LN STE 1
CONWAY AR
72034-3681
US

IV. Provider business mailing address

550 CLUB LN STE 1
CONWAY AR
72034-3681
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-1510
  • Fax: 501-329-5697
Mailing address:
  • Phone: 501-329-1510
  • Fax: 501-329-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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