Provider Demographics
NPI:1497770424
Name:CONWAY REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER INC
Other - Org Name:CONWAY REGIONAL MEDICAL CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-2112
Mailing Address - Street 1:2302 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6297
Mailing Address - Country:US
Mailing Address - Phone:501-329-3831
Mailing Address - Fax:501-450-2363
Practice Address - Street 1:2302 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6297
Practice Address - Country:US
Practice Address - Phone:501-329-3831
Practice Address - Fax:501-450-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2657282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102178105Medicaid
10015OtherCIGNA HEALTHCARE OF AR
5000028OtherAARP HEALTHCARE-UHC
AR10029OtherBLUE CROSS BLUE SHIELD
AR102222002Medicaid
107347OtherHEALTHLINK-HMO
0607495OtherAETNA
124633OtherUNITED HEALTHCAE
1110762OtherUNITED HEALTHCARE
AR770006305OtherBREASTCARE
0607495OtherAETNA
10015OtherCIGNA HEALTHCARE OF AR
107347OtherHEALTHLINK-HMO
=========30OtherQUALCHOICE
5000028OtherAARP HEALTHCARE-UHC