Healthcare Provider Details

I. General information

NPI: 1578559787
Provider Name (Legal Business Name): CONWAY REGIONAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ADA AVE SUITE 100
CONWAY AR
72034-4985
US

IV. Provider business mailing address

2200 ADA AVE SUITE 100
CONWAY AR
72034-4985
US

V. Phone/Fax

Practice location:
  • Phone: 501-730-0754
  • Fax: 501-730-0718
Mailing address:
  • Phone: 501-730-0754
  • Fax: 501-730-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number041036
License Number StateAR

VIII. Authorized Official

Name: NANCY BURNETT
Title or Position: DIRECTOR
Credential: RN
Phone: 501-730-0754