Provider Demographics
NPI:1073783189
Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Other - Org Name:FAMILY PRACTICE & SURGICAL SPECIALITS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:RINEHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-263-1620
Mailing Address - Street 1:116 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SCHLESWIG
Mailing Address - State:IA
Mailing Address - Zip Code:51461-4041
Mailing Address - Country:US
Mailing Address - Phone:712-263-3672
Mailing Address - Fax:
Practice Address - Street 1:116 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SCHLESWIG
Practice Address - State:IA
Practice Address - Zip Code:51461-4041
Practice Address - Country:US
Practice Address - Phone:712-263-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154542Medicaid
IA52805OtherWELLMARK
IA52805Medicare PIN