Conway Regional Medical Center Inc

Key facts

NPI: 1104642180
Entity type: Organization (NPI type 2)
Primary specialty: Neurology Physician 2084N0400X
Legal business name: CONWAY REGIONAL MEDICAL CENTER INC
Practice address: 2200 Ada Ave Ste 302a
Conway, AR 72034-4985
Phone: (501) 932-0352
Fax: (501) 932-0354
NPI assigned: Nov 25, 2024
Organization subpart: No

Authorized official

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Annette N. Anderson, MD Geriatric Psychiatry Physician · Conway, AR · NPI 1811170301

Medicare reassignment NPD AR
Savannah Bradbury, PA-C Medical Physician Assistant · Conway, AR · NPI 1326468059

Medicare reassignment NPD AR
Dallas M Bondhus, PA Medical Physician Assistant · Conway, AR · NPI 1205826187

Medicare reassignment AR

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AR

All facility ownership & control disclosures 8

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

Facility	Type	Role	Since
Conway Regional Rehabilitation Hospital LLC Conway, AR · CCN 043033	Hospital	5% Or Greater Direct Ownership Interest (69.6%)	Apr 6, 2004
Dardanelle Regional Medical Center Dardanelle, AR · CCN 04Z302	Hospital	5% Or Greater Indirect Ownership Interest (100%)	Jan 1, 2022
Dardanelle Regional Medical Center Dardanelle, AR · CCN 04M302	Hospital	5% Or Greater Indirect Ownership Interest (100%)	Jan 1, 2022
Dardanelle Regional Medical Center Dardanelle, AR · CCN 041302	Hospital	5% Or Greater Indirect Ownership Interest (100%)	Jan 1, 2022
Conway Regional Medical Clinic - Vilonia Vilonia, AR · CCN 048536	Rural health clinic	Operational/Managerial Control (100%)	Dec 11, 2014
Greenbrier Family Medicine Greenbrier, AR · CCN 048534	Rural health clinic	5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control	Oct 25, 2004 Oct 25, 2004
Mayflower Medical Clinic Mayflower, AR · CCN 048537	Rural health clinic	5% Or Greater Direct Ownership Interest (100%)	Oct 25, 2004
Clinton Medical Clinic Clinton, AR · CCN 048563	Rural health clinic	5% Or Greater Direct Ownership Interest (100%)	Oct 25, 2004

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20250123003847	AR	Part B Supplier - Hospital Department(S)	3173428414	Receives reassigned benefits from 3 practitioners Practice locations: Conway, AR

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Neurology Physician Group: 193400000X SINGLE SPECIALTY GROUP	2084N0400X			Yes

Addresses

Primary practice location

2200 Ada Ave Ste 302a
Conway, AR 72034-4985

Mailing address

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

Other names

Conway Regional NeuroScience Clinic Doing business as

Other providers in Conway, AR

All providers in Conway, AR · Neurology Physician in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.