Healthcare Provider Details

I. General information

NPI: 1306893268
Provider Name (Legal Business Name): NORTHWEST MEDICAL CENTER ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N COLLEGE ST
ALBANY MO
64402-1433
US

IV. Provider business mailing address

705 N COLLEGE ST
ALBANY MO
64402-1433
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number98-47
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number98-52
License Number StateMO

VIII. Authorized Official

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