Provider Demographics
NPI:1245330265
Name:NEVADA CITY HOSPITAL
Entity type:Organization
Organization Name:NEVADA CITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
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 STREET
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:417-448-3641
Practice Address - Street 1:810 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:MO
Practice Address - Zip Code:64784-9223
Practice Address - Country:US
Practice Address - Phone:417-884-5006
Practice Address - Fax:417-884-2801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA CITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19043261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593872302Medicaid
MO28017018OtherBLUE CROSS GROUP NUMBER
MO593872302Medicaid