Provider Demographics
NPI:1215586714
Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Other - Org Name:MIDDLE PARK MEDICAL CENTER - WINTER PARK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLASEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-699-2413
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:KREMMLING
Mailing Address - State:CO
Mailing Address - Zip Code:80459-0399
Mailing Address - Country:US
Mailing Address - Phone:970-724-3171
Mailing Address - Fax:970-724-9606
Practice Address - Street 1:47 COOPER CREEK WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-0000
Practice Address - Country:US
Practice Address - Phone:970-887-5839
Practice Address - Fax:970-724-9446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KREMMLING MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-06
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000220220Medicaid