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General NPI Number Information
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NPI Number | 1710513957
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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 | 03/19/2020
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 1700 ALTUS ST STE 110
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City | CONWAY
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State | AR
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Zip | 72032-4299
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Country | US
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Telephone | 501-852-1366
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Fax | 501-852-1367
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Provider Business Mailing Address
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Address Line | 1700 ALTUS ST STE 110
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City | CONWAY
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State | AR
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Zip | 72032-4299
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Country | US
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Telephone | 501-852-1366
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Fax | 501-852-1367
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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