Healthcare Provider Details

I. General information

NPI: 1619969086
Provider Name (Legal Business Name): CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 1ST AVE S
DENISON IA
51442-2210
US

IV. Provider business mailing address

2020 1ST AVE S
DENISON IA
51442-2210
US

V. Phone/Fax

Practice location:
  • Phone: 712-263-5021
  • Fax: 712-263-1600
Mailing address:
  • Phone: 712-263-5021
  • Fax: 712-263-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number240173H
License Number StateIA

VIII. Authorized Official

Name: MR. MARK H. RINEHARDT
Title or Position: ADMINISTRATOR AND CEO
Credential:
Phone: 712-263-1620