Provider Demographics
NPI:1174793285
Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-265-2505
Mailing Address - Street 1:100 MEDICAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2607
Mailing Address - Country:US
Mailing Address - Phone:712-265-2700
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:100 MEDICAL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2607
Practice Address - Country:US
Practice Address - Phone:712-265-2700
Practice Address - Fax:712-263-1777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154542Medicaid
IA51356OtherWELLMARK
IA51356Medicare PIN