NPIMap

Organization Active NPI

Golden Valley Memorial Hospital District

Doing business as Golden Valley Medical - Warsaw

  • 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
Doing business as
Golden Valley Medical - Warsaw
Practice address
1771 Commercial St
Warsaw, MO 65355-3096
Phone
(660) 438-5193
NPI assigned
May 5, 2006
Last updated
Feb 20, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

Addresses

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

  • Golden Valley Medical - Warsaw Doing business as

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366490971. Details of each certification follow.

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.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 7

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

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

National Provider Directory

National Provider Directory
Part of
Golden Valley Hospital

Locations

675 3rd St
Osceola, MO 64776
Phone (417) 646-2231

50 Hillcrest Medical Blvd
Ste 102
Waco, TX 76712
Phone (254) 202-7204

Ownership & related parties

All disclosed owners & managing parties 8

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

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 71

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 71

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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.