Provider Demographics
NPI:1306157656
Name:CONWAY REGIONAL MEDICAL CENTER,INC,
Entity type:Organization
Organization Name:CONWAY REGIONAL MEDICAL CENTER,INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-2491
Mailing Address - Street 1:525 WESTERN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 WESTERN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-450-2491
Practice Address - Fax:501-450-2283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONWAY REGIONAL MEDICAL CENTER,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical