1417049511 NPI number — NEVADA CITY HOSPITAL

Table of content: (NPI 1417049511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417049511 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 RICH HILL 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:
1417049511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2022
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:
417-448-3848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 N. 14TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICH HILL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64779-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-395-2150
Provider Business Practice Location Address Fax Number:
417-395-2153
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANGLIN
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
417-448-3626

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: 21902019 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 597677509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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