NPIMap

Organization Active NPI

Clearwater County Memorial Hospital

Doing business as Clearwater Health Services

  • Critical Access Hospital
  • Bagley, MN
National Provider Identifier
1295859411
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
334510 Issued in MN
Legal business name
CLEARWATER COUNTY MEMORIAL HOSPITAL
Doing business as
Clearwater Health Services
Practice address
203 4TH St. N.W.
Bagley, MN 56621
Phone
(218) 694-6501
Fax
(281) 694-3592
NPI assigned
Mar 16, 2007
Last updated
Jan 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Authorized official

Name
Nora Jennings
Title
Administrative Secretary
Phone
(218) 694-6501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 334510 MN Primary

Addresses

Primary practice location

203 4TH St. N.W.
Bagley, MN 56621

Mailing address

203 4TH St. N.W.
Bagley, MN 56621
Phone (218) 694-6501

Other names 1

  • Clearwater Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295859411. Details of each certification follow.

Hospital certification: CCN 240096

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CLEARWATER COUNTY MEMORIAL HOSPITAL
Certification status
Terminated Other: provider status change, Feb 1, 2002
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 30, 2001
Beds
25
Ownership / control type
Local
Facility address
203 4TH Street NW
Bagley, MN 56621

National Provider Directory

National Provider Directory

Locations

22 Elm St
#67
Clearbrook, MN 56634
Phone (218) 776-3184

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1295859411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 4TH ST. N.W.",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "56621",
            "telephone_number": "218-694-6501",
            "fax_number": "281-694-3528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 4TH ST. N.W.",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "56621",
            "telephone_number": "218-694-6501",
            "fax_number": "281-694-3592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "NORA",
        "authorized_official_title_or_position": "ADMINISTRATIVE SECRETARY",
        "authorized_official_telephone_number": "218-694-6501"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "334510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearwater Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bagley, MN

Sources for this page

Verify at the official NPI Registry.