1245330265 NPI number — NEVADA CITY HOSPITAL

Table of content: (NPI 1245330265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245330265 NPI number — NEVADA CITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA CITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEVADA REGIONAL MEDICAL CENTER SHELDON FAMILY MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245330265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S. ASH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64772-3223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-667-3355
Provider Business Mailing Address Fax Number:
417-448-3641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 W. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64784-9223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-884-5006
Provider Business Practice Location Address Fax Number:
417-884-2801
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
GREG
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
417-448-3618

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  19043 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593872302 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28017018 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com