Provider Demographics
NPI:1083609184
Name:QUINN, KENT S (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:S
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 66971
Mailing Address - Street 2:DEPT MR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6971
Mailing Address - Country:US
Mailing Address - Phone:303-465-0401
Mailing Address - Fax:303-438-1351
Practice Address - Street 1:1 GOOD SAMARITAN WAY
Practice Address - Street 2:ATTN RADIOLOGY DEPT
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2402
Practice Address - Country:US
Practice Address - Phone:618-242-4600
Practice Address - Fax:618-242-4600
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-07-05
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Provider Licenses
StateLicense IDTaxonomies
IA211812085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7191098*Medicaid
IAA02918Medicare UPIN
IA7191098*Medicaid