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General NPI Number Information
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NPI Number | 1396913976
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Entity Type | Organization
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Legal Business Name | CONWAY REGIONAL MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 2302 COLLEGE AVE STE 100
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City | CONWAY
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State | AR
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Zip | 72034-6297
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Country | US
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Telephone | 501-513-5385
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Fax | 501-513-5257
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Provider Business Mailing Address
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Address Line | PO BOX 9662
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City | CONWAY
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State | AR
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Zip | 72033-9662
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Country | US
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Telephone | 501-745-4914
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Fax | 501-745-6374
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Authorized Official
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Title or Position | CFO
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Name | WILLIAM PACK
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Credential |
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Telephone | 501-450-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2657
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License Number State | AR
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