Healthcare Provider Details

I. General information

NPI: 1790806842
Provider Name (Legal Business Name): NORTHWEST HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 RHODE ISLAND
KING CITY MO
64463
US

IV. Provider business mailing address

305 RHODE ISLAND
KING CITY MO
64463
US

V. Phone/Fax

Practice location:
  • Phone: 660-535-4347
  • Fax: 660-535-6240
Mailing address:
  • Phone: 660-535-4347
  • Fax: 660-535-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MATT YOUNGER
Title or Position: CEO
Credential:
Phone: 816-232-6818