MEDICARE: NORTHWEST HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790806842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	305 RHODE ISLAND
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463
Country	:	US
Telephone Number	:	660-535-4347
Fax Number	:	660-535-6240

Provider Business Practice Location Address
First Line	:	305 RHODE ISLAND
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463
Country	:	US
Telephone Number	:	660-535-4347
Fax Number	:	660-535-6240

Authorized Official
Title or Position	:	CEO
Name	:	MATT YOUNGER
Credential	:
Telephone Number	:	816-232-6818

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	11/10/2021

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