NPIMap

Organization Active NPI

Crawford County Memorial Hospital

  • Rural Health Clinic/Center
  • Denison, IA
National Provider Identifier
1134586811
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
240173H Issued in IA
Legal business name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Practice address
115 N 14TH St
Denison, IA 51442-1452
Phone
(712) 263-5071
Fax
(712) 263-6106
NPI assigned
Jan 26, 2016
Organization subpart
Yes
Parent organization
CRAWFORD COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Billy J Bruce
Title
Chief Executive Officer
Phone
(712) 265-2502

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X 240173H IA Primary
Family Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SF0001X

Addresses

Primary practice location

115 N 14TH St
Denison, IA 51442-1452

Mailing address

115 N 14TH St
Denison, IA 51442-1452
Phone (712) 263-5071

Other identifiers 2

IdentifierTypeStateIssuer
1134586811MedicaidIA
1134586811OtherIANPI

Other names 1

  • CCMH Medical Clinic - City Center Doing business as

National Provider Directory

National Provider Directory
Part of
Crawford Co Mem Hosp ER

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1134586811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N 14TH ST",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514421452",
            "telephone_number": "712-263-5071",
            "fax_number": "712-263-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N 14TH ST",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514421452",
            "telephone_number": "712-263-5071",
            "fax_number": "712-263-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2016-01-26",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "BILLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "712-265-2502",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IA",
            "license": "240173H",
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134586811",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1134586811",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Medical Clinic - City Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denison, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.