Basic Information
| Provider Information | |||||||||
| NPI: | 1831659564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST HEALTH SERVICES INC | ||||||||
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| OtherOrganizationName: | GALLATIN MIDDLE SCHOOL BASED HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645064954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162718262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 S OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646409471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162718262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | YOUNGER | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8162326818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.