MEDICARE: NORTHWEST HEALTH SERVICES, INC.

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	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)		MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	F290000A	OTHER		MEDICARE PART B ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261031	OTHER	MO	FQHC FACILITY NUMBER

General Provider Information

NPI Number	:	1861646168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2303 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4954
Country	:	US
Telephone Number	:	816-271-8219
Fax Number	:	816-232-2696

Provider Business Practice Location Address
First Line	:	503 S 6TH ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-2224
Country	:	US
Telephone Number	:	816-233-5188
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MATT YOUNGER
Credential	:
Telephone Number	:	816-232-6818

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/10/2021

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Directions to “NORTHWEST HEALTH SERVICES, INC. ” Practice Location

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