Provider Demographics
NPI:1730402249
Name:CONWAY REGIONAL MEDICAL CENTER, INC
Entity type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:501-358-6695
Mailing Address - Fax:501-358-6860
Practice Address - Street 1:495 HOGAN LN STE 2
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8498
Practice Address - Country:US
Practice Address - Phone:501-358-6695
Practice Address - Fax:501-358-6860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONWAY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1110762OtherUNITED HEALTHCARE
AR10029OtherBLUE CROSS BLUE SHIELD
10015OtherCIGNA HEALTHCARE OF AR
124633OtherUNITED HEALTHCARE
107347OtherHEALTHLINK-HMO
0607495OtherAETNA
5000028OtherAARP HEALTHCARE-UHC
AR102178105Medicaid
107347OtherHEALTHLINK-HMO
5000028OtherAARP HEALTHCARE-UHC
=========30OtherQUALCHOICE
AR102222002Medicaid
AR102222002Medicaid
AR040029Medicare PIN