NPIMap

Organization Active NPI

Conway Regional Medical Center, Inc

Doing business as Conway Regional Multispecialty Clinic

  • Pulmonary Disease Physician
  • Conway, AR
National Provider Identifier
1003478462
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
CONWAY REGIONAL MEDICAL CENTER, INC
Doing business as
Conway Regional Multispecialty Clinic
Practice address
525 Western Ave Ste 305a
Conway, AR 72034-4982
Phone
(501) 358-6145
Fax
(501) 504-6642
NPI assigned
Jul 5, 2019
Last updated
Jan 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Pack
Title
Cfo
Phone
(501) 450-2112

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU
Hematology (Internal Medicine) Physician 207RH0000X NU
Pulmonary Disease Physician 207RP1001X NU Primary
Rheumatology Physician 207RR0500X NU

Addresses

Primary practice location

525 Western Ave Ste 305a
Conway, AR 72034-4982

Mailing address

PO Box 9662
Conway, AR 72033-9662
Phone (501) 852-1363

Other names 1

  • Conway Regional Multispecialty Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191002000685 AR Part B Supplier - Hospital Department(S) 3173428414 Receives reassigned benefits from 6 practitioners
Practice locations: Conway, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2297040Conway Regional Multispecialty Clinic525 Western Ave Ste 305, Conway, AR 72034Provider-performed microscopyJan 9, 2028

National Provider Directory

National Provider Directory

Locations

525 Western Ave
Ste 305
Conway, AR 72034
Phone (501) 358-6145

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Conway Regional Rehabilitation Hospital LLCConway, AR, CCN 043033 Hospital 5% Or Greater Direct Ownership Interest (69.6%) Apr 6, 2004
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04Z302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04M302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 041302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Conway Regional Medical Clinic - ViloniaVilonia, AR, CCN 048536 Rural health clinic Operational/Managerial Control (100%) Dec 11, 2014
Greenbrier Family MedicineGreenbrier, AR, CCN 048534 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 25, 2004
Oct 25, 2004
Mayflower Medical ClinicMayflower, AR, CCN 048537 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2004
Clinton Medical ClinicClinton, AR, CCN 048563 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2004

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1003478462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9662",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720339662",
            "telephone_number": "501-852-1363",
            "fax_number": "501-852-1364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 WESTERN AVE STE 305A",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344982",
            "telephone_number": "501-358-6145",
            "fax_number": "501-504-6642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-05",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "PACK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "501-450-2112"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Regional Multispecialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conway Regional Multispecialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.