Healthcare Provider Details

I. General information

NPI: 1538615927
Provider Name (Legal Business Name): CONWAY REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WESTERN AVE SUITE 202
CONWAY AR
72034-4967
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-5337
  • Fax: 501-513-5338
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2657
License Number StateAR

VIII. Authorized Official

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