MEDICARE: GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	257-33	MO
2	251E00000X	Home Health Agency	169-25HH	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	360840	OTHER	FIRST GUARD
3	32578013	OTHER	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	760500	OTHER	FAMILY HEALTH PARTNERS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033109103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1600 NORTH SECOND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	660-885-5088
Fax Number	:	660-885-7756

Provider Business Practice Location Address
First Line	:	1703 N 2ND ST.
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	660-885-5088
Fax Number	:	660-885-7756

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	MEREDITH COOPER
Credential	:
Telephone Number	:	660-885-8171

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	02/23/2023

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Directions to “GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT ” Practice Location

Language	Start Address	Practice Location

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