Provider Demographics
NPI:1912904814
Name:KEEFE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:KEEFE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:719-767-5662
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0578
Mailing Address - Country:US
Mailing Address - Phone:719-767-5661
Mailing Address - Fax:719-767-8042
Practice Address - Street 1:602 NORTH 6TH STREET WEST
Practice Address - Street 2:
Practice Address - City:CHEYENNE WELLS
Practice Address - State:CO
Practice Address - Zip Code:80810-0578
Practice Address - Country:US
Practice Address - Phone:719-767-5661
Practice Address - Fax:719-767-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010232282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05043005Medicaid
CO05043005Medicaid