Healthcare Provider Details

I. General information

NPI: 1396866737
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: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 5TH AVE
SAINT JOSEPH MO
64505-2111
US

IV. Provider business mailing address

PO BOX 803886
KANSAS CITY MO
64180-2631
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-3338
  • Fax: 813-233-4777
Mailing address:
  • Phone: 816-271-8265
  • Fax: 813-233-4777

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