Healthcare Provider Details

I. General information

NPI: 1548424757
Provider Name (Legal Business Name): NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E US HIGHWAY 136 NMC ALBANY CLINIC WEST
ALBANY MO
64402-8210
US

IV. Provider business mailing address

705 N COLLEGE ST NORTHWEST MEDICAL CENTER
ALBANY MO
64402-1433
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3311
  • Fax:
Mailing address:
  • Phone: 660-726-3941
  • Fax: 660-726-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number104860
License Number StateMO

VIII. Authorized Official

Name: DWIGHT CARVELL
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 816-273-0437