Provider Demographics
NPI:1275100109
Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:CLECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-208-2907
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:970-887-5800
Mailing Address - Fax:970-887-5891
Practice Address - Street 1:1000 GRANBY PARK DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-8900
Practice Address - Country:US
Practice Address - Phone:970-887-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KREMMLING MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05090006Medicaid