1033109103 NPI number — GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT

Table of content: (NPI 1033109103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033109103 NPI number — GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
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:
Provider Other Organization Name Type Code:
6
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:
1033109103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 NORTH SECOND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64735-1192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-885-5088
Provider Business Mailing Address Fax Number:
660-885-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 N 2ND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64735-1192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-885-5088
Provider Business Practice Location Address Fax Number:
660-885-7756
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
MEREDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
660-885-8171

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  257-33 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 169-25HH , 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: 283787901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 360840 . This is a "FIRST GUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32578013 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 580565604 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 760500 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263787905 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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