Provider Demographics
NPI:1376054155
Name:CONWAY REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER, INC
Other - Org Name:CONWAY REGIONAL GASTROENTEROLOGY CENTER
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 1:2200 ADA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4984
Mailing Address - Country:US
Mailing Address - Phone:501-852-1360
Mailing Address - Fax:501-552-5316
Practice Address - Street 1:2200 ADA AVE STE 201
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4984
Practice Address - Country:US
Practice Address - Phone:501-852-1360
Practice Address - Fax:501-552-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty