Provider Demographics
NPI:1912067612
Name:NORTHWEST HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHWEST HEALTH SERVICES, INC.
Other - Org Name:NORTHWEST PHARMACY SERVICES
Other - Org Type:Doing Business As
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:816-385-5993
Mailing Address - Street 1:103 E. CROSS STREET
Mailing Address - Street 2:P.O. BOX 156
Mailing Address - City:HAMILTON
Mailing Address - State:MO
Mailing Address - Zip Code:64644-1434
Mailing Address - Country:US
Mailing Address - Phone:816-583-2881
Mailing Address - Fax:816-583-2883
Practice Address - Street 1:103 E. CROSS STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-0156
Practice Address - Country:US
Practice Address - Phone:816-583-2881
Practice Address - Fax:816-583-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020257653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO605889302Medicaid
MO2634764OtherNABP NUMBER
MO605889302Medicaid