Basic Information
| Provider Information | |||||||||
| NPI: | 1063418424 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 HOSPITAL LOOP | ||||||||
| Address2: | |||||||||
| City: | CRAIG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816258750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708249411 | ||||||||
| FaxNumber: | 9708263119 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 HOSPITAL LOOP | ||||||||
| Address2: | |||||||||
| City: | CRAIG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708249411 | ||||||||
| FaxNumber: | 9708263119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF QUALITY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9708263106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 261QR1300X | 0093 | CO | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 341600000X | N | Transportation Services | Ambulance | 282NC0060X | 0093 | CO | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 06060164 | 05 | CO | MEDICAID | 24031020 | 05 | CO | MEDICAID | 05046008 | 05 | CO | MEDICAID | 04003463 | 05 | CO | MEDICAID | 04139309 | 05 | CO | MEDICAID |