Conway Regional Medical Center Inc
Organization Active NPI Clinical Medical Laboratory · Conway, AR
NPI 1609123017 · NPPES record last updated Jun 26, 2018
Key facts
- NPI
- 1609123017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 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
- Organization subpart
- No
Authorized official
- Name
- Stephanie Cothran
- Title
- Manager
- Phone
- (501) 745-2122
Owners & managing parties with NPI records 3
-
Thad Ridge Hardin, M.D.
-
Thaddeus Michael Stanton, M.D.
Other NPIs on the same Medicare enrollment 5
Related certifications (CCN) 3
Affiliated clinicians 490
-
Jose Abiseid, M.D.
-
Dana C Abraham, M.D.
-
Ladly Abraham, MD
-
Shirisha Ale, MBBS
-
Justin Lane Alexander, CRNA
-
Ahmed Ali, MD
-
Ashley Allen, PA-C
-
Justin Allen, MD
-
Moustafa Aly, MD
-
Megan Andres, APRN
-
Edward E Angtuaco, M.D.
-
Becca Carle Austin, APN
-
Mallory Bagwell, DO
-
Diaa An Bahgat, MD.
-
Phillip Scott Ballinger, M.D.
-
Jodi M Barboza, MD
-
Tyeler Barker, MD
-
Jaafar Basma, M.D.
Medicare Care Compare: Hospital
- Listed as
- Conway Regional Medical Center, Inc
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
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
- Corporation · Non-profit
- Incorporated
- Sep 26, 1938 in AR
- Enrollment address
- 2302 College Avenue
Conway, AR 72034-6297 - Hospital subgroups
- Acute care, Psychiatric unit
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Allison Bramlett |
W-2 Managing Employee |
Jan 1, 2024 | |
| Susan Gatto |
Operational/Managerial Control |
Jan 1, 2022 | |
| Thaddeus Michael Stanton |
Operational/Managerial Control |
Jan 1, 2024 | |
| William Pack |
W-2 Managing Employee |
Aug 29, 2022 | |
| Operational/Managerial Control |
Aug 29, 2022 | ||
| Matthew Troup |
Corporate Officer |
Sep 14, 2015 | |
| Jeremy O Riddle |
Operational/Managerial Control |
Jan 1, 2024 | |
| Thad R Hardin |
Operational/Managerial Control |
Jan 1, 2017 | |
| Jeffrey Standridge |
Operational/Managerial Control |
Jan 1, 2017 | |
| Tom Poe |
Operational/Managerial Control |
Jan 1, 2013 | |
| Gena Ester |
Operational/Managerial Control |
Jan 1, 2022 | |
| Andrew Cole |
Operational/Managerial Control |
Jan 1, 2012 | |
| Wayne Cox |
Operational/Managerial Control |
Jan 1, 2013 | |
| Bryan Bruich |
Operational/Managerial Control |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Yes |
Addresses
Primary practice location
2302 College Ave
Conway, AR 72034
Mailing address
2302 College Ave
Conway, AR 72034-6297
Phone (501) 329-3831
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10029 | Other | AR | BLUE CROSS BLUE SHIELD |
| 10015 | Other | AR | CIGNA |
| 102178105 | Medicaid | AR | |
| 107347 | Other | AR | HEALTHLINK-HMO |
| 0607495 | Other | AR | AETNA |
| 124633 | Other | AR | UNITED HEALTHCARE |
Other providers in Conway, AR
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc
- Conway Regional Medical Center Inc.
- Conway Regional Medical Center, Inc
All providers in Conway, AR · Clinical Medical Laboratory in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2018. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.