Provider Demographics
NPI:1679227276
Name:NORTHWEST HEALTH SERVICES INC
Entity Type:Organization
Organization Name:NORTHWEST HEALTH SERVICES INC
Other - Org Name:CHILLICOTHE PHARMACY SERVICES
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:816-385-5993
Mailing Address - Street 1:300 W BUS HWY 36
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3264
Mailing Address - Country:US
Mailing Address - Phone:660-280-2502
Mailing Address - Fax:816-463-8638
Practice Address - Street 1:300 W BUS HWY 36
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3264
Practice Address - Country:US
Practice Address - Phone:660-280-2502
Practice Address - Fax:816-463-8638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2647773OtherNCPDP
MO600111098Medicaid