Provider Demographics
NPI:1447313721
Name:NORTHWEST MEDICAL CENTER ASSOCIATION INC
Entity type:Organization
Organization Name:NORTHWEST MEDICAL CENTER ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-273-0473
Mailing Address - Street 1:705 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-1433
Mailing Address - Country:US
Mailing Address - Phone:660-726-3941
Mailing Address - Fax:
Practice Address - Street 1:705 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-1433
Practice Address - Country:US
Practice Address - Phone:660-726-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL CENTER ASSOCIATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO541084307Medicaid