1215150735 NPI number — NORTHWEST FAMILY HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215150735 NPI number — NORTHWEST FAMILY HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST FAMILY HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215150735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 S POLK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64469-4030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-449-2123
Provider Business Mailing Address Fax Number:
816-449-2125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 S POLK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64469-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-449-2123
Provider Business Practice Location Address Fax Number:
816-449-2125
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIEHL
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-449-2123

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DB1347 . This is a "RAILROAD MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P900000 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 593197007 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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