Provider Demographics
NPI:1619969086
Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND CEO
Authorized Official - Prefix:MR
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 1:2020 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2210
Mailing Address - Country:US
Mailing Address - Phone:712-263-5021
Mailing Address - Fax:712-263-1600
Practice Address - Street 1:2020 1ST AVE S
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2210
Practice Address - Country:US
Practice Address - Phone:712-263-5021
Practice Address - Fax:712-263-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA240173H261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24612OtherMEDICARE GROUP BILLING
IA0246124Medicaid