SOUTH SIDE HEALTH CENTER – NPI #1194846550
Clinic/Center

SOUTH SIDE HEALTH CENTER is an AHC clinic located in SAINT JOSEPH, MO. NPPES has assigned the NPI number 1194846550 to SOUTH SIDE HEALTH CENTER on April 03, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SOUTH SIDE HEALTH CENTER” is a dba name, the actual legal business name for this organization is NORTHWEST HEALTH SERVICES INC. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 5 years ago on Nov 10, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTH SIDE HEALTH CENTER below.

NPI Profile for
NORTHWEST HEALTH SERVICES INC

NPI Number
1194846550
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
NORTHWEST HEALTH SERVICES INC
Doing Business As (dba): SOUTH SIDE HEALTH CENTER
Primary location
5001 LAKE AVE
SAINT JOSEPH, MO 64504-1170
Phone: (816) 238-7788 Fax: (816) 238-9285
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MATT YOUNGER
CEO
Phone: (816) 232-6818
Updated
Certification Date
Nov 10, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SOUTH SIDE HEALTH CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMO509384202
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
207Q00000X
- Family Medicine

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.