Basic Information
| Provider Information | |||||||||
| NPI: | 1932838562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELTA COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10100 | ||||||||
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| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814160008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708747681 | ||||||||
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| Practice Location | |||||||||
| Address1: | 95 STAFFORD LN # NA | ||||||||
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| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087480269 | ||||||||
| FaxNumber: | 9708745430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2022 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | HEYN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9708747681 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DELTA COUNTY MEMORIAL HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.