Healthcare Provider Details

I. General information

NPI: 1609123017
Provider Name (Legal Business Name): CONWAY REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 COLLEGE AVE
CONWAY AR
72034
US

IV. Provider business mailing address

2302 COLLEGE AVE
CONWAY AR
72034-6297
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3831
  • Fax: 501-450-2363
Mailing address:
  • Phone: 501-329-3831
  • Fax: 501-450-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE COTHRAN
Title or Position: MANAGER
Credential:
Phone: 501-745-2122