Provider Demographics
NPI:1053433920
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: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:816-232-6818
Mailing Address - Street 1:707 VICTORY LANE
Mailing Address - Street 2:
Mailing Address - City:CAINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64632
Mailing Address - Country:US
Mailing Address - Phone:660-893-5750
Mailing Address - Fax:660-893-5751
Practice Address - Street 1:707 VICTORY LANE
Practice Address - Street 2:
Practice Address - City:CAINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64632
Practice Address - Country:US
Practice Address - Phone:660-893-5750
Practice Address - Fax:660-893-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506065309Medicaid
261865Medicare ID - Type UnspecifiedFQHC MEDICARE GROUP #
CN7865Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
1450000HMedicare ID - Type UnspecifiedPART B MEDICARE GROUP #