Provider Demographics
NPI:1215059209
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 1:109 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRAYMER
Mailing Address - State:MO
Mailing Address - Zip Code:64624-0036
Mailing Address - Country:US
Mailing Address - Phone:660-645-2218
Mailing Address - Fax:660-645-2820
Practice Address - Street 1:109 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRAYMER
Practice Address - State:MO
Practice Address - Zip Code:64624
Practice Address - Country:US
Practice Address - Phone:660-645-2218
Practice Address - Fax:660-645-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
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
MO501330435Medicaid
MO501330435Medicaid
DD8059Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
1450000GMedicare ID - Type UnspecifiedPART B MEDICARE #