Provider Demographics
NPI:1467642041
Name:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Other - Org Name:MOSAIC ANESTHESIA ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOOLITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-726-3941
Mailing Address - Street 1:705 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-1433
Mailing Address - Country:US
Mailing Address - Phone:660-726-3941
Mailing Address - Fax:660-726-3647
Practice Address - Street 1:705 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-1433
Practice Address - Country:US
Practice Address - Phone:660-726-3941
Practice Address - Fax:660-726-3647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918404203OtherWM. E. BRADE, CRNA - ME
MO919902106OtherDARIN J. WARD, CRNA - MED
MO541084307Medicaid
MO919902106OtherDARIN J. WARD, CRNA - MED