1215586714 NPI number — KREMMLING MEMORIAL HOSPITAL DISTRICT

Table of content: (NPI 1215586714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215586714 NPI number — KREMMLING MEMORIAL HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KREMMLING MEMORIAL HOSPITAL DISTRICT
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:
Provider Other Organization Name Type Code:
6
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:
1215586714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KREMMLING
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80459-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-724-3171
Provider Business Mailing Address Fax Number:
970-724-9606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 COOPER CREEK WAY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80482-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-887-5839
Provider Business Practice Location Address Fax Number:
970-724-9446
Provider Enumeration Date:
09/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CLASEN
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR, BUSINESS OPERATIONS
Authorized Official Telephone Number:
307-699-2413

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000220220 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com