Healthcare Provider Details

I. General information

NPI: 1457321176
Provider Name (Legal Business Name): CLEARWATER COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 4TH ST NW
BAGLEY MN
56621-8306
US

IV. Provider business mailing address

123 4TH ST NW
BAGLEY MN
56621-8306
US

V. Phone/Fax

Practice location:
  • Phone: 218-694-2384
  • Fax: 218-694-6687
Mailing address:
  • Phone: 218-694-2384
  • Fax: 218-694-6687

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: NORA C. JENNINGS
Title or Position: ADMIN SECRETARY
Credential:
Phone: 218-694-6501