| Conway Regional Hendrix Medical Clinic | |
|
1700 Altus St Ste 110 Conway AR 72032-4299 | |
| (501) 852-1366 | |
| (501) 852-1367 |
| Full Name | Conway Regional Hendrix Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1700 Altus St Ste 110, 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 Hendrix Medical Clinic 1700 Altus St Ste 110 Conway AR 72032-4299 Ph: (501) 852-1366 | Conway Regional Hendrix Medical Clinic 1700 Altus St Ste 110 Conway AR 72032-4299 Ph: (501) 852-1366 |
| NPI Number | 1710513957 |
|---|---|
| Provider Enumeration Date | 03/19/2020 |
| Last Update Date | 11/09/2023 |
| Medicare PECOS PAC ID | 3173428414 |
|---|---|
| Medicare Enrollment ID | O20200602000925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710513957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Reda Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699763441 PECOS PAC ID: 3779687561 Enrollment ID: I20070404000196 |
| Provider Name | Keith Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295732816 PECOS PAC ID: 1658405212 Enrollment ID: I20100818000119 |
| Provider Name | James Richard Fulmer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093030918 PECOS PAC ID: 8628211083 Enrollment ID: I20131021000785 |
| Provider Name | Allison Tiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285094052 PECOS PAC ID: 6002115821 Enrollment ID: I20160429000610 |
| Provider Name | Kathryn N Deacon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598289746 PECOS PAC ID: 5991078305 Enrollment ID: I20170907000539 |
| Provider Name | Stephanie Rittman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730851775 PECOS PAC ID: 4981093606 Enrollment ID: I20211117002281 |
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