Provider Demographics
NPI:1841200417
Name:CONWAY REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER INC
Other - Org Name:CONWAY MEDICAL GROUP
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 1:437 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6127
Mailing Address - Country:US
Mailing Address - Phone:501-327-1325
Mailing Address - Fax:501-327-1328
Practice Address - Street 1:437 DENISON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6127
Practice Address - Country:US
Practice Address - Phone:501-327-1325
Practice Address - Fax:501-327-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126827002Medicaid
AR126827002Medicaid
AR5B597Medicare PIN