Healthcare Provider Details

I. General information

NPI: 1134586811
Provider Name (Legal Business Name): CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 14TH ST
DENISON IA
51442-1452
US

IV. Provider business mailing address

115 N 14TH ST
DENISON IA
51442-1452
US

V. Phone/Fax

Practice location:
  • Phone: 712-263-5071
  • Fax: 712-263-6106
Mailing address:
  • Phone: 712-263-5071
  • Fax: 712-263-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number240173H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BILLY J BRUCE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 712-265-2502