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NPI Code Detail

MEDICARE: CONWAY REGIONAL MEDICAL CENTER, INC

MEDICARE: CONWAY REGIONAL MEDICAL CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianAR

General Provider Information

NPI Number : 1376054155
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONWAY REGIONAL MEDICAL CENTER, INC
Provider Business Mailing Address
First Line : 2200 ADA AVE STE 201
Second Line :
City : CONWAY
State : AR
Zip : 72034-4984
Country : US
Telephone Number : 501-852-1360
Fax Number : 501-552-5316
Provider Business Practice Location Address
First Line : 2200 ADA AVE STE 201
Second Line :
City : CONWAY
State : AR
Zip : 72034-4984
Country : US
Telephone Number : 501-852-1360
Fax Number : 501-552-5316
Authorized Official
Title or Position : CFO
Name : WILLIAM PACK
Credential :
Telephone Number : 501-450-2112
Provider Enumeration Date : 10/19/2017
Last Update Date : 11/09/2023

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Directions to “CONWAY REGIONAL MEDICAL CENTER, INC ” Practice Location

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