NPIMap

Organization Active NPI

Crawford County Memorial Hospital

  • Family Medicine Physician
  • Denison, IA
National Provider Identifier
1174793285
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Practice address
100 Medical Pkwy
Suite a
Denison, IA 51442-2607
Phone
(712) 265-2700
Fax
(712) 263-1777
NPI assigned
Mar 4, 2008
Organization subpart
Yes
Parent organization
CRAWFORD COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Authorized official

Name
Nancy J. Carlson
Title
Chief Financial Officer
Phone
(712) 265-2505

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

100 Medical Pkwy
Suite a
Denison, IA 51442-2607

Mailing address

100 Medical Pkwy
Suite a
Denison, IA 51442-2607
Phone (712) 265-2700

Other identifiers 2

IdentifierTypeStateIssuer
0154542MedicaidIA
51356OtherIAWELLMARK

Other names 1

  • CCMH Medical Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Crawford Co Mem Hosp ER8 organizations share this tax ID, including this one
Part of
Crawford Co Mem Hosp ER

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1174793285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "address_2": "SUITE A",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422607",
            "telephone_number": "712-265-2700",
            "fax_number": "712-263-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "address_2": "SUITE A",
            "city": "DENISON",
            "state": "IA",
            "postal_code": "514422607",
            "telephone_number": "712-265-2700",
            "fax_number": "712-263-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRAWFORD COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2008-03-04",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "712-265-2505"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154542",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "51356",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 28, 2011; 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.