Healthcare Provider Details

I. General information

NPI: 1104893700
Provider Name (Legal Business Name): CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PKWY STE A & B
DENISON IA
51442-2614
US

IV. Provider business mailing address

100 MEDICAL PKWY STE A
DENISON IA
51442-2614
US

V. Phone/Fax

Practice location:
  • Phone: 712-265-2700
  • Fax: 712-263-1777
Mailing address:
  • Phone: 712-265-2700
  • Fax: 712-263-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN C MUCK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 712-265-2506