| Conway Regional Infectious Disease Clinic | |
|
525 Western Ave Ste 301 Conway AR 72034-4981 | |
| (501) 513-5295 | |
| (501) 513-5296 |
| Full Name | Conway Regional Infectious Disease Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 525 Western Ave Ste 301, Conway, Arkansas |
| Authorized Official Name and Position | William Pack (CFO) |
| Authorized Official Contact | 5014502112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Conway Regional Infectious Disease Clinic Po Box 9662 Conway AR 72033-9662 Ph: (501) 852-1363 | Conway Regional Infectious Disease Clinic 525 Western Ave Ste 301 Conway AR 72034-4981 Ph: (501) 513-5295 |
| NPI Number | 1376025544 |
|---|---|
| Provider Enumeration Date | 09/04/2018 |
| Last Update Date | 11/09/2023 |
| Medicare PECOS PAC ID | 3173428414 |
|---|---|
| Medicare Enrollment ID | O20181127001256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376025544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (Arkansas) | Primary |
| Provider Name | Mary J Burgess |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1407011968 PECOS PAC ID: 7719025824 Enrollment ID: I20140910000994 |
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