Healthcare Provider Details

I. General information

NPI: 1245330265
Provider Name (Legal Business Name): NEVADA CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W. MAIN STREET
SHELDON MO
64784-9223
US

IV. Provider business mailing address

800 S. ASH STREET
NEVADA MO
64772-3223
US

V. Phone/Fax

Practice location:
  • Phone: 417-884-5006
  • Fax: 417-884-2801
Mailing address:
  • Phone: 417-667-3355
  • Fax: 417-448-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number19043
License Number StateMO

VIII. Authorized Official

Name: GREG L. SHAW
Title or Position: CFO
Credential:
Phone: 417-448-3618