Healthcare Provider Details

I. General information

NPI: 1912067612
Provider Name (Legal Business Name): NORTHWEST HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E. CROSS STREET
HAMILTON MO
64644-0156
US

IV. Provider business mailing address

103 E. CROSS STREET P.O. BOX 156
HAMILTON MO
64644-1434
US

V. Phone/Fax

Practice location:
  • Phone: 816-583-2881
  • Fax: 816-583-2883
Mailing address:
  • Phone: 816-583-2881
  • Fax: 816-583-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002025765
License Number StateMO

VIII. Authorized Official

Name: MATT YOUNGER
Title or Position: C.E.O.
Credential:
Phone: 816-385-5993