East Phillips County Hospital District
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Holyoke, CO
NPI 1912915893 · NPPES record last updated Jan 4, 2023
Key facts
- NPI
- 1912915893
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 0586 (CO)
- Legal business name
- EAST PHILLIPS COUNTY HOSPITAL DISTRICT
- Practice address
- 1001 E Johnson Street
Holyoke, CO 80734-1854 - Phone
- (970) 854-2241
- Fax
- (970) 854-3821
- NPI assigned
- Aug 4, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Authorized official
- Name
- Michael Hassell
- Title
- Ceo
- Phone
- (970) 854-2241
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 41
-
Jessica Leigh Bullard, FNP-C
-
Sean Patrick Fitzgerald, MSN FNP-C
-
Preston Keith Nein, M.D.
-
Jessica Rose Skomp, FNP-C
-
Eirawen Luettgen, ARNP, FNP, ENP
-
Amy Roden, NP-C
-
Gary Dale Montgomery, PA-C
-
Angela Widler, PA
-
Pepper Knight Etters, PA-C
-
Anthony James Guglielmo, FNP-BC
-
Erik Bowman, M.D.
-
Lauren Elizabeth Gerk, DNP, CRNA
-
Dennis J. Jelden, MD
-
Behzad Molavi, M.D.
-
Rajesh K Sharma, M.D.,F.A.C.C.
-
Maheep Singh Sohal, M.D.
-
Erin Kelly Flynn, PA-C
Affiliated clinicians 4
-
Angela Widler, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Hospital certification: CCN 06Z305
- Legal name
- EAST PHILLIPS COUNTY HOSPITAL DISTRICT
- Doing business as
- MELISSA MEMORIAL HOSPITAL
- Organization structure
- Other · Non-profit
- Enrollment address
- 1001 E Johnson St
Holyoke, CO 80734-1854
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Steve Young |
Operational/Managerial Control |
Jan 1, 1993 | |
| Christopher J Alvarez |
W-2 Managing Employee |
Feb 16, 2026 | |
| Operational/Managerial Control |
Feb 16, 2026 | ||
| Sheila Gift |
Operational/Managerial Control |
Feb 1, 2015 | |
| Maribeth Olson |
W-2 Managing Employee |
Feb 16, 2026 | |
| Operational/Managerial Control |
Feb 16, 2026 | ||
| Jimmie Bailey |
Corporate Officer |
Aug 16, 2021 | |
| W-2 Managing Employee |
Aug 16, 2021 | ||
| Operational/Managerial Control |
Aug 16, 2021 | ||
| Gary Rahe |
Operational/Managerial Control |
May 1, 2008 | |
| Michael Hassell |
Corporate Officer |
Nov 7, 2022 | |
| W-2 Managing Employee |
Nov 7, 2022 | ||
| Operational/Managerial Control |
Nov 7, 2022 | ||
| Angela Powell |
Operational/Managerial Control |
May 1, 2014 | |
| Julie Wiebke |
Operational/Managerial Control |
Apr 27, 2021 | |
| East Phillips County Hospital District |
5% Or Greater Direct Ownership Interest | Jul 11, 1966 | 100% |
| Jessie Diamond |
W-2 Managing Employee |
Oct 9, 2019 | |
| Operational/Managerial Control |
Oct 9, 2019 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Melissa Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 11, 1966 |
| Family Practice of Holyoke |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080626000643 | CO | Part a Provider - Critical Access Hospital | 9638161615 |
Receives reassigned benefits from 31 practitioners Practice locations: Holyoke, CO |
National Provider Directory
- Tax ID family
- Melissa Memorial Hospital
- Part of
- Melissa Memorial Hospital
Locations
1001 E Johnson St
Holyoke, CO 80734
Phone (970) 854-2241
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 0586 | CO | Yes |
Addresses
Primary practice location
1001 E Johnson Street
Holyoke, CO 80734-1854
Mailing address
1001 E. Johnson Street
Holyoke, CO 80734-1854
Phone (970) 854-2241
Other names
- Melissa Memorial Hospital SwingBed
Other providers in Holyoke, CO
- East Phillips County Hospital District
- East Phillips County Hospital District
- East Phillips County Hospital District
- East Phillips County Hospital District
- East Phillips County Hospital District
- East Phillips County Hospital District
- East Phillips County Hospital District
- Family Care Clinic
- Flatland Center for Brain LLC
- Flatland Center for Brain LLC
All providers in Holyoke, CO · Medicare Defined Swing Bed Hospital Unit in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.