NPIMap

Organization Active NPI

Golden Valley Memorial Hospital District

  • General Acute Care Hospital
  • Clinton, MO
National Provider Identifier
1710075361
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Practice address
1600 N 2ND St
Clinton, MO 64735-1192
Phone
(660) 890-7103
Fax
(660) 885-6496
NPI assigned
Oct 10, 2006
Last updated
Sep 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Authorized official

Name
Mackenzie Conner
Title
Medical Staff Services
Phone
(660) 885-5511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

1600 N 2ND St
Clinton, MO 64735-1192

Mailing address

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 890-7103

Other practice location 1

1771 Commercial St
Warsaw, MO 65355-3096
Phone (660) 438-5193

Other practice location 2

675 3rd St
Osceola, MO 64776-2934
Phone (417) 646-2246

Other practice location 3

100 S Tebo St
Windsor, MO 65360-1161
Phone (660) 647-2147

Other practice location 4

1602 N 2nd St
Clinton, MO 64735-1192
Phone (660) 885-5511

Other identifiers 4

IdentifierTypeStateIssuer
540565603MedicaidMO
010565604MedicaidMO
355172107MedicaidMO
800565608MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20070530000571 MO Part A Provider - Hospital 4688561814 Practice locations: Clinton, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710075361. Details of each certification follow.

Hospital certification: CCN 260175

Legal name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Doing business as
GOLDEN VALLEY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 29, 1972
Last certification
Dec 27, 2011
Beds
65
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Jun 10, 2019 in MO
Enrollment address
1600 N 2ND St
Clinton, MO 64735-1192
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved, Rehabilitation unit

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Golden Valley Memorial HospitalCCN 260175 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

100 S Tebo St
Windsor, MO 65360
Phone (660) 647-2134

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
William R Kelsay Individual Corporate Director Mar 1, 2007
George Lowe Individual Corporate Director Apr 4, 2006
Craig Thompson Individual Corporate Officer Oct 1, 2014
Tammy Nadler Individual W-2 Managing EmployeeController Feb 7, 2007
Ken Lanning Individual W-2 Managing Employee Apr 23, 2010
Tim Glasscock Individual Corporate Director Mar 1, 2007
Danny Eidson Individual Corporate Director Apr 25, 2007
James C Johns Individual Corporate Director May 23, 2018
Dena Cambers Individual Corporate Director Apr 27, 2011

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Golden Valley Medical-WarsawWarsaw, MO, CCN 268588 Rural health clinic Operational/Managerial Control
Other		 Apr 4, 2004
Apr 4, 2004
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 2

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

Practitioners & affiliated clinicians

Practitioners 166

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 166

Affiliated clinicians 268

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 268

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1710075361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-890-7103",
            "fax_number": "660-885-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-890-7103",
            "fax_number": "660-885-6496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1771 Commercial St",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "MO",
            "postal_code": "653553096",
            "country_code": "US",
            "telephone_number": "660-438-5193",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "675 3rd St",
            "address_purpose": "LOCATION",
            "city": "Osceola",
            "state": "MO",
            "postal_code": "647762934",
            "country_code": "US",
            "telephone_number": "417-646-2246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Tebo St",
            "address_purpose": "LOCATION",
            "city": "Windsor",
            "state": "MO",
            "postal_code": "653601161",
            "country_code": "US",
            "telephone_number": "660-647-2147",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1602 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MO",
            "postal_code": "647351192",
            "country_code": "US",
            "telephone_number": "660-885-5511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "MEDICAL STAFF SERVICES",
        "authorized_official_telephone_number": "660-885-5511"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540565603",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010565604",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355172107",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800565608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

Verify at the official NPI Registry.