Northwest Missouri State University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTHWEST MISSOURI STATE UNIVERSITY

Doing business as

Northwest Missouri State

Practice address

800 University Drive
Maryville, MO 64468

Phone

(660) 562-1313

NPI assigned

Sep 15, 2011

Last updated

Feb 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Cannella, LATNPI 1164961108

Title

Head Athletic Trainer

Phone

(660) 562-1313

Specialties & licenses 2

Addresses

Other names 1

• Northwest Missouri State Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Cannella, ATC

  • Athletic Trainer
  • Las Vegas, NV
  • NPI 1164961108
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1225310204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 UNIVERSITY DRIVE",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "64468",
            "telephone_number": "660-562-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 UNIVERSITY DRIVE",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "64468",
            "telephone_number": "660-562-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MISSOURI STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-15",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "CANNELLA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "HEAD ATHLETIC TRAINER",
        "authorized_official_telephone_number": "660-562-1313",
        "authorized_official_credential": "LAT"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Missouri State",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northwest Chiropractic Clinic
• Northwest Chiropractic Clinic, LLC
• Northwest Health Services, Inc (Maryville High School Health Center)
• Northwest Health Services, Inc. (Maryville Middle School Health Center)
• Northwest Health Services, Inc. (Maryville Elementary School Health Center)
• Northwest Missouri State University (NWMSU Wellness Center)
• Kendra O'Riley
• Parkdale Manor Health & Rehabilitation LLC
• Parkdale Manor Incorporated (Parkdale Manor Care Center)
• Casey R. Parman, APN

• Family Medicine Physician in Maryville, MO
• Providers in Maryville, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.