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General NPI Number Information
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NPI Number | 1306814306
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Entity Type | Organization
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Legal Business Name | GOLDEN VALLEY EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 1600 N 2ND ST
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City | CLINTON
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State | MO
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Zip | 64735-1192
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Country | US
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Telephone | 660-885-6690
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Fax | 660-885-2619
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Provider Business Mailing Address
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Address Line | P.O. BOX 699
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City | SHAWNEE MISSION
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State | KS
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Zip | 66201-0699
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Country | US
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Telephone | 913-469-4244
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Fax | 913-469-1939
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SHELLI LEONARD
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Credential |
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Telephone | 913-469-4244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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