NPIMap

Organization Active NPI

Conway Regional Medical Center Inc

  • Clinical Medical Laboratory
  • Conway, AR
National Provider Identifier
1609123017
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CONWAY REGIONAL MEDICAL CENTER INC
Practice address
2302 College Ave
Conway, AR 72034
Phone
(501) 329-3831
Fax
(501) 450-2363
NPI assigned
Aug 6, 2012
Last updated
Jun 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Authorized official

Name
Stephanie Cothran
Title
Manager
Phone
(501) 745-2122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2302 College Ave
Conway, AR 72034

Mailing address

2302 College Ave
Conway, AR 72034-6297
Phone (501) 329-3831

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071201000077 AR Part A Provider - Hospital 3173428414 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Greenbrier, AR; Mayflower, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609123017. Details of each certification follow.

Hospital certification: CCN 040029

Legal name
CONWAY REGIONAL MEDICAL CENTER INC
Doing business as
CONWAY REGIONAL MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 25, 2021
Beds
150
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1938 in AR
Enrollment address
2302 College Avenue
Conway, AR 72034-6297
Other Hospital Practice Location
Hospital subgroups
Acute care, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Conway Regional Medical Center, IncCCN 040029 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Allison Bramlett Individual W-2 Managing EmployeeDelegated Official Jan 1, 2024
Susan Gatto Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Thaddeus Michael Stanton Individual Operational/Managerial ControlBoard Member Jan 1, 2024
William Pack Individual W-2 Managing EmployeeCfo Aug 29, 2022
Operational/Managerial ControlCfo Aug 29, 2022
Matthew Troup Individual Corporate OfficerPresident & Ceo Sep 14, 2015
Jeremy O Riddle Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Thad R Hardin Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Jeffrey Standridge Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Tom Poe Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Gena Ester Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Andrew Cole Individual Operational/Managerial ControlBoard Member Jan 1, 2012
Wayne Cox Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Bryan Bruich Individual Operational/Managerial ControlBoard Member Jan 1, 2022

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 490

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 490

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1609123017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346297",
            "telephone_number": "501-329-3831",
            "fax_number": "501-450-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-329-3831",
            "fax_number": "501-450-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-06",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "COTHRAN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "501-745-2122"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.