Provider Demographics
NPI:1275990871
Name:CONWAY REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER, INC.
Other - Org Name:CONWAY REGIONAL MEDICAL CLINIC-PRINCE ST.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-2112
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:501-852-1364
Practice Address - Street 1:1 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4912
Practice Address - Country:US
Practice Address - Phone:501-329-2948
Practice Address - Fax:501-450-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty