NPIMap

Organization Active NPI

Conway Regional Medical Center Inc.

Doing business as Conway Regional Medical Clinic-Pottsville

  • Rural Health Clinic/Center
  • Pottsville, AR
National Provider Identifier
1811446206
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CONWAY REGIONAL MEDICAL CENTER INC.
Doing business as
Conway Regional Medical Clinic-Pottsville
Practice address
5395 W Ash St
Suite 2
Pottsville, AR 72858-9170
Phone
(479) 880-1118
Fax
(479) 219-5013
NPI assigned
Sep 26, 2016
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

5395 W Ash St
Suite 2
Pottsville, AR 72858-9170

Mailing address

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

Other names 1

  • Conway Regional Medical Clinic-Pottsville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040605000199 AR Part B Supplier - Clinic/Group Practice 3173428414 Receives reassigned benefits from 50 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Pottsville, AR; Mayflower, AR; Greenbrier, AR; Clinton, AR

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1811446206",
    "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": "5395 W ASH ST",
            "address_2": "SUITE 2",
            "city": "POTTSVILLE",
            "state": "AR",
            "postal_code": "728589170",
            "telephone_number": "479-880-1118",
            "fax_number": "479-219-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Regional Medical Clinic-Pottsville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conway Regional Medical Clinic-Pottsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pottsville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.