Provider Demographics
NPI:1740775212
Name:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Entity Type:Organization
Organization Name:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Other - Org Name:WESTSIDE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CARMEL
Authorized Official - Last Name:JUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN
Authorized Official - Phone:816-344-5201
Mailing Address - Street 1:904 S 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2400
Mailing Address - Country:US
Mailing Address - Phone:816-233-5188
Mailing Address - Fax:816-344-5247
Practice Address - Street 1:904 S 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2400
Practice Address - Country:US
Practice Address - Phone:816-344-5201
Practice Address - Fax:816-355-5247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL WELFARE BOARD OF THE COUNTY OF BUCHANAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497024145Medicaid
MO1497024145OtherCOMMERCIAL