Provider Demographics
NPI:1295859411
Name:CLEARWATER COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLEARWATER COUNTY MEMORIAL HOSPITAL
Other - Org Name:CLEARWATER HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-694-6501
Mailing Address - Street 1:203 4TH ST. N.W.
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621
Mailing Address - Country:US
Mailing Address - Phone:218-694-6501
Mailing Address - Fax:281-694-3528
Practice Address - Street 1:203 4TH ST. N.W.
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621
Practice Address - Country:US
Practice Address - Phone:218-694-6501
Practice Address - Fax:281-694-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334510282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241328Medicare Oscar/Certification
MN24Z328Medicare Oscar/Certification