NPIMap

Organization Active NPI

The Memorial Hospital

  • Rural Health Clinic/Center
  • Craig, CO
National Provider Identifier
1316757073
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THE MEMORIAL HOSPITAL
Practice address
750 Hospital Loop
Craig, CO 81625-8750
Phone
(970) 824-9411
Fax
(970) 826-3116
NPI assigned
Jan 13, 2025
Last updated
Jan 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Annalia Bailey
Title
Provider Relations Coordinator
Phone
(970) 824-9411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

750 Hospital Loop
Craig, CO 81625-8750

Mailing address

750 Hospital Loop
Craig, CO 81625-8750
Phone (970) 824-9411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170525000121 CO Part A Provider - Rural Health Clinic 1254231533 1 other NPI on this enrollment
Practice locations: Craig, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316757073. Details of each certification follow.

Rural health clinic certification: CCN 063410

Legal name
THE MEMORIAL HOSPITAL
Doing business as
MEMORIAL REGIONAL HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 26, 2017
Last certification
Jun 28, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentProprietary
Enrollment address
750 Hospital Loop
Craig, CO 81625-8750
Related CCNs
061314

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hospital10 organizations share this tax ID, including this one
Part of
Memorial Hospital

Other organizations with this tax ID 9

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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brittany Johnson Individual Corporate OfficerChief Financial Officer Jan 1, 2017
County of Moffat Organization, Craig, CO 5% Or Greater Direct Ownership Interest May 1, 2017 100%
Kelly Hepworth Individual Corporate DirectorBoard of Trustee Member Jan 1, 2017 20%
Amy Updike Individual Corporate DirectorBoard of Trustee Member Jan 1, 2022 20%
Allan Reishus Individual Corporate DirectorBoard of Trustee Member Jan 1, 2021 20%
Jennifer Riley Individual Corporate OfficerChief Executive Officer Dec 1, 2010 20%
W-2 Managing EmployeeVice President Operations Dec 1, 2010 20%
Forrest Luke Individual Corporate DirectorBoard of Trustee Member May 18, 2010 20%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • County of Moffat

    dba Moffat County Public Health

    • Public Health or Welfare Agency
    • Craig, CO
    • NPI 1164054292

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1316757073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 HOSPITAL LOOP",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816258750",
            "telephone_number": "970-824-9411",
            "fax_number": "970-826-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 HOSPITAL LOOP",
            "city": "CRAIG",
            "state": "CO",
            "postal_code": "816258750",
            "telephone_number": "970-824-9411",
            "fax_number": "970-826-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MEMORIAL HOSPITAL",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "ANNALIA",
        "authorized_official_title_or_position": "PROVIDER RELATIONS COORDINATOR",
        "authorized_official_telephone_number": "970-824-9411"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Craig, CO

Sources for this page

Verify at the official NPI Registry.