The Memorial Hospital
Organization Active NPI Land Ambulance · Craig, CO
NPI 1669288809 · NPPES record last updated Dec 3, 2024
Key facts
- NPI
- 1669288809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- 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
- Dec 3, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- THE MEMORIAL HOSPITAL
Authorized official
- Name
- Amber L Turvey
- Title
- Revenue Cycle Director
- Phone
- (970) 826-3126
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 9
Member of 1
Related certifications (CCN) 4
Practitioners 94
-
Melissa Anne Almon, BSW
-
Lynn Marie Ames, PMHNP-BC
-
Timothy Michael Balise, PA-C
-
Kelsie Bond, PA-C
-
Allison Marie Dobbie, M.D.
-
Susan C Dockins, FNP-BC
-
Evan C Fleming, PA
-
Suzanne Haag, PAC
-
Jillian M. Hess, MD
-
Marcus H Howell, MD
-
Patrick Bobryk Johnston, D.O.
-
Larry Wayne Kipe, MD
-
Alfred W Maina, CRNA
-
Alejandro David Miranda, M.D.
-
Bridget Mucha, NP
-
Ryan Anne Murphy, M.D.
-
Jessica Nyquist, PA-C
-
Caroline Perry, PA
Affiliated clinicians 121
-
Travis Anderson, MD
-
William B Baker, M.D.
-
Timothy Michael Balise, PA-C
-
Mary Shannon Clow Becker, M.D.
-
Kelsie Bond, PA-C
-
John R Bumgarner, M.D.
-
Taylor Lee Burgart, DNP
-
Jordan Christensen, D.O.
-
Nicole Mes Cotter, M.D.
-
Calvin J Cruz, M.D.
-
Andalib Danandeh, MD
-
Jessica K Devin, MD
-
Allison Marie Dobbie, M.D.
-
Norman Lee Dockins, DMSC, PA-C
-
Susan C Dockins, FNP-BC
-
Alexandra Donovan, M.D.
-
Jona M Ely, NP
-
Roy E Erb, M.D.
Medicare Care Compare: Hospital
- Listed as
- Memorial Hospital, the
- Type
- Critical Access Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
Hospital certification: CCN 061314
- Legal name
- THE MEMORIAL HOSPITAL
- Doing business as
- MEMORIAL REGIONAL HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Mar 1, 2002
- Last certification
- Jul 19, 2018
- Beds
- 25
- Ownership / control type
- Local
- Organization structure
- Government · Non-profit
- Incorporated
- in CO
- Enrollment address
- 750 Hospital Loop
Craig, CO 81625-2019
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Denise K Arola |
Corporate Director |
May 1, 2020 | |
| County of Moffat |
5% Or Greater Direct Ownership Interest | Jan 1, 1966 | 100% |
| Kelly Hepworth |
Corporate Director |
Jan 31, 2017 | |
| John Ponikvar |
Corporate Director |
May 1, 2023 | |
| Steve Hilley |
Corporate Director |
May 1, 2024 | |
| Allan Reishus |
Corporate Director |
May 1, 2021 | |
| Jennifer Riley |
Corporate Officer |
Dec 1, 2010 | |
| W-2 Managing Employee | Oct 21, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061104000568 | CO | Part a Provider - Critical Access Hospital | 1254231533 |
Receives reassigned benefits from 77 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Craig, CO |
| O20250203003583 | CO | Part B Supplier - Ambulance Service Supplier | 1254231533 | Practice locations: Craig, CO |
National Provider Directory
- Tax ID family
- Memorial Hospital
- Part of
- Memorial Hospital
Locations
785 Russell St
#100
Craig, CO 81625
Phone (970) 824-5759
473 Yampa Ave
Craig, CO 81625
Phone (970) 824-5992
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
750 Hospital Loop
Craig, CO 81625-8750
Mailing address
750 Hospital Loop
Craig, CO 81625-8750
Phone (970) 824-9411
Other names
- Memorial Regional Health
Other providers in Craig, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.