Provider Demographics
NPI:1033109517
Name:NEVADA CITY HOSPITAL
Entity Type:Organization
Organization Name:NEVADA CITY HOSPITAL
Other - Org Name:NEVADA REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-448-3618
Mailing Address - Street 1:800 S. ASH
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3223
Mailing Address - Country:US
Mailing Address - Phone:417-667-3355
Mailing Address - Fax:417-448-3691
Practice Address - Street 1:800 S. ASH
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3223
Practice Address - Country:US
Practice Address - Phone:417-667-3355
Practice Address - Fax:417-448-3691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA CITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580419000Medicaid
MO820419000Medicaid
MO820419000Medicaid
MO261650Medicare Oscar/Certification