Provider Demographics
NPI:1831312925
Name:WRAY COMMUNITY DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:WRAY COMMUNITY DISTRICT HOSPITAL
Other - Org Name:WRAY COMMUNITY DISTRICT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STULTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-332-4811
Mailing Address - Street 1:1017 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-1420
Mailing Address - Country:US
Mailing Address - Phone:970-332-4811
Mailing Address - Fax:970-332-4017
Practice Address - Street 1:1017 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1420
Practice Address - Country:US
Practice Address - Phone:970-332-4811
Practice Address - Fax:970-332-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0628275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05053004Medicaid
CO05053004Medicaid
CO06Z309Medicare Oscar/Certification