Healthcare Provider Details

I. General information

NPI: 1912190620
Provider Name (Legal Business Name): NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E US HIGHWAY 136
ALBANY MO
64402-8223
US

IV. Provider business mailing address

1607 E US HIGHWAY 136
ALBANY MO
64402-8223
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3333
  • Fax: 660-726-3232
Mailing address:
  • Phone: 660-726-3333
  • Fax: 660-726-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number115802
License Number StateMO

VIII. Authorized Official

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