MEDICARE: CLEARWATER COUNTY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114998457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATER COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 67
Second Line	:
City	:	CLEARBROOK
State	:	MN
Zip	:	56634-0067
Country	:	US
Telephone Number	:	218-694-3124
Fax Number	:	218-694-3184

Provider Business Practice Location Address
First Line	:	22 ELM STREET NW
Second Line	:
City	:	CLEARBROOK
State	:	MN
Zip	:	56634
Country	:	US
Telephone Number	:	218-694-3124
Fax Number	:	218-694-3184

Authorized Official
Title or Position	:	ADMIN SECRETARY
Name	:	NORA C JENNINGS
Credential	:
Telephone Number	:	218-694-6501

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/17/2012

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