Provider Demographics
NPI:1104893700
Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-265-2506
Mailing Address - Street 1:100 MEDICAL PKWY
Mailing Address - Street 2:STE A
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2614
Mailing Address - Country:US
Mailing Address - Phone:712-265-2700
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:100 MEDICAL PKWY
Practice Address - Street 2:STE A & B
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2614
Practice Address - Country:US
Practice Address - Phone:712-265-2700
Practice Address - Fax:712-263-1777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-02
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154542Medicaid
IA51356OtherWELLMARK
IA0154542Medicaid
IA168535Medicare Oscar/Certification
IA0154542Medicaid
IA52805OtherWELLMARK