Provider Demographics
NPI:1396866737
Name:NORTHWEST HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:NORTHWEST HEALTH SERVICES, INC
Other - Org Name:NORTH END HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-6818
Mailing Address - Street 1:PO BOX 803886
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2631
Mailing Address - Country:US
Mailing Address - Phone:816-271-8265
Mailing Address - Fax:813-233-4777
Practice Address - Street 1:1000 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64505-2111
Practice Address - Country:US
Practice Address - Phone:816-233-3338
Practice Address - Fax:813-233-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509384608Medicaid
DD8059Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
MO509384608Medicaid
261874Medicare ID - Type UnspecifiedFQHC MEDICARE GROUP #