Conway Regional Medical Center Inc
Organization Active NPI Cardiovascular Disease Physician · Conway, AR
NPI 1639624372 · NPPES record last updated Jun 18, 2025
Key facts
- NPI
- 1639624372
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- CONWAY REGIONAL MEDICAL CENTER INC
- Practice address
- 525 Western Ave
Suite 202
Conway, AR 72034-4967 - Phone
- (501) 513-5337
- Fax
- (501) 513-5338
- NPI assigned
- Aug 23, 2016
- Organization subpart
- No
Authorized official
- Name
- Matthew Troup
- Title
- Ceo/President
- Phone
- (501) 450-2111
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 14
Practitioners 11
-
Yalcin Hacioglu, M.D.
-
Rimsha Hasan, M.D.
-
Felicia Mae Johnson, APRN
-
Alexa Shipp, APRN
-
Donald E. Steely, M.D.
-
Lane Gray Wagnon, N.P.
-
Kayla Jo Bond, APRN
-
Evan Wade Gregory, M.D.
-
Stephen Hudson, M.D.
-
Reda Denise Reed, APN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Conway Regional Rehabilitation Hospital LLC |
Hospital | 5% Or Greater Direct Ownership Interest (69.6%) | Apr 6, 2004 |
| Dardanelle Regional Medical Center |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2022 |
| Dardanelle Regional Medical Center |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2022 |
| Dardanelle Regional Medical Center |
Hospital | 5% Or Greater Indirect Ownership Interest (100%) | Jan 1, 2022 |
| Conway Regional Medical Clinic - Vilonia |
Rural health clinic | Operational/Managerial Control (100%) | Dec 11, 2014 |
| Greenbrier Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Oct 25, 2004 Oct 25, 2004 |
| Mayflower Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 25, 2004 |
| Clinton Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 25, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161014001291 | AR | Part B Supplier - Clinic/Group Practice | 3173428414 |
Receives reassigned benefits from 8 practitioners 1 other NPI on this enrollment Practice locations: Conway, AR; Dardanelle, AR; Greenbrier, AR; Mayflower, AR; Russellville, AR; Vilonia, AR |
National Provider Directory
- Tax ID family
- Center Ridge Family Med
Locations
525 Western Ave
Ste 2
Conway, AR 72034
Phone (501) 358-6905
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes |
Addresses
Primary practice location
525 Western Ave
Suite 202
Conway, AR 72034-4967
Mailing address
PO Box 9662
Conway, AR 72033-9662
Phone (501) 852-1363
Other names
- Conway Regional Cardiovascular Clinic
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 · Cardiovascular Disease 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 Jun 18, 2025. 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.