Provider Demographics
NPI:1366490971
Name:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:GOLDEN VALLEY MEDICAL - WARSAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-885-8171
Mailing Address - Street 1:1771 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3157
Mailing Address - Country:US
Mailing Address - Phone:660-438-5193
Mailing Address - Fax:
Practice Address - Street 1:1771 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3096
Practice Address - Country:US
Practice Address - Phone:660-438-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-05
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268588Medicare Oscar/Certification