=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316757073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 HOSPITAL LOOP
-----------------------------------------------------
City | CRAIG
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81625-8750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-824-9411
-----------------------------------------------------
Fax | 970-826-3116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 HOSPITAL LOOP
-----------------------------------------------------
City | CRAIG
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81625-8750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-824-9411
-----------------------------------------------------
Fax | 970-826-3116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER RELATIONS COORDINATOR
-----------------------------------------------------
Name | ANNALIA BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-824-9411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------