Basic Information
| Provider Information | |||||||||
| NPI: | 1306814306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN VALLEY EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 699 | ||||||||
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| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662010699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N 2ND ST | ||||||||
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| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647351192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608856690 | ||||||||
| FaxNumber: | 6608852619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | SHELLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9134694244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.