Provider Demographics
NPI:1891733879
Name:EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Other - Org Name:MELISSA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-854-2241
Mailing Address - Street 1:1001 E JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1854
Mailing Address - Country:US
Mailing Address - Phone:970-854-2241
Mailing Address - Fax:970-854-3821
Practice Address - Street 1:1001 E JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1854
Practice Address - Country:US
Practice Address - Phone:970-854-2241
Practice Address - Fax:970-854-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0586282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05038005Medicaid
CO06060321Medicaid
CO05038005Medicaid
CO05038005Medicaid
CO2980OtherBCBS PROVIDER NO.
CO06060321Medicaid