Healthcare Provider Details

I. General information

NPI: 1194846550
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

5001 LAKE AVE
SAINT JOSEPH MO
64504-1170
US

IV. Provider business mailing address

5001 LAKE AVE
SAINT JOSEPH MO
64504-1170
US

V. Phone/Fax

Practice location:
  • Phone: 816-238-7788
  • Fax: 816-238-9285
Mailing address:
  • Phone: 816-238-7788
  • Fax: 816-238-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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