Provider Demographics
NPI:1003067349
Name:KEEFE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:KEEFE MEMORIAL HOSPITAL
Other - Org Name:PRAIRIE VIEW CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-767-5662
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0578
Mailing Address - Country:US
Mailing Address - Phone:719-767-5661
Mailing Address - Fax:
Practice Address - Street 1:615 W 5TH N
Practice Address - Street 2:
Practice Address - City:CHEYENNE WELLS
Practice Address - State:CO
Practice Address - Zip Code:80810-0578
Practice Address - Country:US
Practice Address - Phone:719-767-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO063985Medicare Oscar/Certification