Provider Demographics
NPI:1629521539
Name:DELTA COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DELTA COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-2285
Mailing Address - Street 1:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-399-2850
Mailing Address - Fax:970-399-2859
Practice Address - Street 1:70 STAFFORD LN UNIT A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2260
Practice Address - Country:US
Practice Address - Phone:970-874-6008
Practice Address - Fax:970-546-4033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QR1300X, 261QU0200X
CO011145282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO063411OtherMEDICARE RHC NUMBER
CO04825048Medicaid