Healthcare Provider Details

I. General information

NPI: 1164754859
Provider Name (Legal Business Name): NEVADA CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S. ASH STREET SUITE 220
NEVADA MO
64772-3224
US

IV. Provider business mailing address

800 S. ASH STREET
NEVADA MO
64772-3224
US

V. Phone/Fax

Practice location:
  • Phone: 417-448-3644
  • Fax: 417-448-3604
Mailing address:
  • Phone: 417-667-3355
  • Fax: 417-448-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number190-57
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ANGLIN
Title or Position: CEO/AUTHORIZED OFFICIAL
Credential:
Phone: 417-448-3626