Healthcare Provider Details

I. General information

NPI: 1164064358
Provider Name (Legal Business Name): KREMMLING MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MCKINLEY STREET
WALDEN CO
80480-9708
US

IV. Provider business mailing address

PO BOX 399
KREMMLING CO
80459-0399
US

V. Phone/Fax

Practice location:
  • Phone: 970-723-4255
  • Fax: 970-723-4268
Mailing address:
  • Phone: 970-724-3171
  • Fax: 970-724-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY CLASEN
Title or Position: SR. DIRECTOR, BUSINESS OPERATIONS
Credential:
Phone: 307-699-2413