Provider Demographics
NPI:1750457149
Name:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Other - Org Name:MOSAIC FAMILY CARE STANBERRY
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:
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-1358
Practice Address - Country:US
Practice Address - Phone:660-783-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590158309Medicaid
MO590158309Medicaid