1063418424 NPI number — THE MEMORIAL HOSPITAL

Table of content: (NPI 1063418424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063418424 NPI number — THE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEMORIAL REGIONAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063418424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 HOSPITAL LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRAIG
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81625-8750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-824-9411
Provider Business Mailing Address Fax Number:
970-826-3119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 HOSPITAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAIG
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-824-9411
Provider Business Practice Location Address Fax Number:
970-826-3119
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAGLEY
Authorized Official First Name:
CAITLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER RELATIONS COORDINATOR
Authorized Official Telephone Number:
970-826-3132

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  0093 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 0093 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04139309 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06060164 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04003463 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05046008 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24031020 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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