Provider Demographics
| NPI: | 1467497677 |
|---|---|
| Name: | NORTHWEST HEALTH SERVICES INC |
| Entity type: | Organization |
| Organization Name: | NORTHWEST HEALTH SERVICES INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | C.E.O. |
| 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: | P.O. BOX 803886 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | KANSAS CITY |
| Mailing Address - State: | MO |
| Mailing Address - Zip Code: | 64180-3886 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 816-232-1486 |
| Mailing Address - Fax: | 816-232-2991 |
| Practice Address - Street 1: | 2303 VILLAGE DRIVE |
| Practice Address - Street 2: | |
| Practice Address - City: | ST. JOSEPH |
| Practice Address - State: | MO |
| Practice Address - Zip Code: | 64506-4954 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 816-232-6818 |
| Practice Address - Fax: | 816-232-2696 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-19 |
| Last Update Date: | 2021-09-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| N660000 | Medicare Oscar/Certification | ||
| 1450000E | Medicare Oscar/Certification | ||
| 261834 | Medicare Oscar/Certification | ||
| 1450000C | Medicare Oscar/Certification | ||
| 1450000F | Medicare Oscar/Certification | ||
| 261803 | Medicare Oscar/Certification | ||
| 261031 | Medicare Oscar/Certification | ||
| F290000A | Medicare Oscar/Certification | ||
| 1450000A | Medicare Oscar/Certification | ||
| 261874 | Medicare Oscar/Certification | ||
| 261875 | Medicare Oscar/Certification | ||
| 261865 | Medicare Oscar/Certification | ||
| 1450000H | Medicare Oscar/Certification | ||
| 261027 | Medicare Oscar/Certification | ||
| 261817 | Medicare Oscar/Certification | ||
| 261818 | Medicare Oscar/Certification | ||
| 261870 | Medicare Oscar/Certification | ||
| 261845 | Medicare Oscar/Certification | ||
| 1450000G | Medicare Oscar/Certification | ||
| 261819 | Medicare Oscar/Certification |
