Provider Demographics
NPI:1699748327
Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CRAWFORD COUNTY MEMORIAL HOSPITAL
Other - Org Name:
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 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2299
Mailing Address - Country:US
Mailing Address - Phone:712-265-2500
Mailing Address - Fax:712-265-2511
Practice Address - Street 1:100 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2299
Practice Address - Country:US
Practice Address - Phone:712-265-2500
Practice Address - Fax:712-265-2511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA240173H207P00000X
207RH0003X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0266403Medicaid
IA26640OtherWELLMARK
IA0266403Medicaid