Healthcare Provider Details

I. General information

NPI: 1306814306
Provider Name (Legal Business Name): GOLDEN VALLEY EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

P.O. BOX 699
SHAWNEE MISSION KS
66201-0699
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-6690
  • Fax: 660-885-2619
Mailing address:
  • Phone: 913-469-4244
  • Fax: 913-469-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELLI LEONARD
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 913-469-4244