Provider Demographics
NPI:1740839240
Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:KREMMLING MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLASEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-699-2413
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:970-724-3171
Mailing Address - Fax:970-724-9446
Practice Address - Street 1:301 MARINA DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND LAKE
Practice Address - State:CO
Practice Address - Zip Code:80447-0000
Practice Address - Country:US
Practice Address - Phone:970-557-6044
Practice Address - Fax:970-724-9446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KREMMLING MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-06
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141155Medicaid