NPIMap

Organization Active NPI

Golden Valley Memorial Hospital District

  • Rural Health Clinic/Center
  • Warsaw, MO
National Provider Identifier
1366490971
Registry record updated Feb 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Practice address
1771 Commercial St
Warsaw, MO 65355-3096
Phone
(660) 438-5193
NPI assigned
May 5, 2006
Organization subpart
Yes
Parent organization
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kyle Adkins
Title
Administrator
Phone
(660) 885-8171

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 152

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 152

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0446787Golden Valley Medical-Warsaw1771 Commercial Street, Warsaw, MO 65355AccreditationApr 22, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302001348 MO Part A Provider - Rural Health Clinic 4688561814 Practice locations: Warsaw, MO
O20040407001299 MO Part B Supplier - Clinic/Group Practice 4688561814 Receives reassigned benefits from 227 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, MO; Osceola, MO; Warsaw, MO; Windsor, MO

Rural health clinic certification: CCN 268588

Legal name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Doing business as
GOLDEN VALLEY MEDICAL-WARSAW
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 19, 2004
Last certification
Aug 28, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
1771 Commercial St
Warsaw, MO 65355-3096
Related CCNs
260175

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 8

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mackenzie Conner Individual W-2 Managing Employee Oct 14, 2019
William R Kelsay Individual Corporate Director Mar 2, 2004
Craig Thompson Individual Corporate OfficerCeo Jul 1, 2017
Meredith Cooper Individual W-2 Managing Employee Jul 1, 2019
Kyle D Adkins Individual W-2 Managing Employee Oct 18, 2009
Tammy Nadler Individual Corporate OfficerCfo Jul 1, 2015
Golden Valley Memorial Hospital District Organization, Clinton, MO Non-profit Operational/Managerial Control Apr 4, 2004
Other Apr 4, 2004
Tim Glasscock Individual Corporate Director Mar 2, 2004

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Golden Valley Medical - OsceolaOsceola, MO, CCN 268725 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2014

National Provider Directory

National Provider Directory
Part of
Golden Valley District

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

1771 Commercial St
Warsaw, MO 65355-3096

Mailing address

1771 Commercial St
Warsaw, MO 65355-3157
Phone (660) 438-5193

Other names 1

NPPES NPI Registry
  • Golden Valley Medical - Warsaw Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 20, 2014.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392854400000",
    "number": "1366490971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 COMMERCIAL ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653553157",
            "telephone_number": "660-438-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 COMMERCIAL ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653553096",
            "telephone_number": "660-438-5193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2006-05-05",
        "last_updated": "2014-02-20",
        "status": "A",
        "authorized_official_last_name": "ADKINS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "660-885-8171"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Valley Medical - Warsaw",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warsaw, MO

Sources for this page

Verify at the official NPI Registry.