Provider Demographics
NPI:1730359878
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:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:RINEHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-263-1620
Mailing Address - Street 1:2016 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2210
Mailing Address - Country:US
Mailing Address - Phone:712-263-3388
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:542 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANILLA
Practice Address - State:IA
Practice Address - Zip Code:51454-0000
Practice Address - Country:US
Practice Address - Phone:712-654-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154542Medicaid
IA51356OtherWELLMARK
IA51356OtherWELLMARK