Provider Demographics
NPI:1033109103
Name:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-885-8171
Mailing Address - Street 1:1600 NORTH SECOND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1192
Mailing Address - Country:US
Mailing Address - Phone:660-885-5088
Mailing Address - Fax:660-885-7756
Practice Address - Street 1:1703 N 2ND ST.
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1192
Practice Address - Country:US
Practice Address - Phone:660-885-5088
Practice Address - Fax:660-885-7756
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO257-33251E00000X
MO169-25HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO283787901Medicaid
360840OtherFIRST GUARD
32578013OtherBCBS
MO580565604Medicaid
760500OtherFAMILY HEALTH PARTNERS
MO263787905Medicaid
MO283787901Medicaid