Provider Demographics
NPI:1033269337
Name:NORTHWEST COMMUITY SERVICES AGENCY
Entity Type:Organization
Organization Name:NORTHWEST COMMUITY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWHERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-884-2640
Mailing Address - Street 1:1604 W REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5530
Mailing Address - Country:US
Mailing Address - Phone:731-884-2640
Mailing Address - Fax:731-884-2644
Practice Address - Street 1:1604 W REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5530
Practice Address - Country:US
Practice Address - Phone:731-884-2640
Practice Address - Fax:731-884-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000194Medicare ID - Type Unspecified