Provider Demographics
NPI:1154936987
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:
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:970-887-5800
Mailing Address - Fax:970-887-5891
Practice Address - Street 1:1000 GRANBY PARK SOUTH
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-8900
Practice Address - Country:US
Practice Address - Phone:970-887-5800
Practice Address - Fax:970-887-5891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KREMMLING MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05090006Medicaid