Provider Demographics
NPI:1093403065
Name:QUAD INTERMED COMPANY LLC
Entity Type:Organization
Organization Name:QUAD INTERMED COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-898-7500
Mailing Address - Street 1:308 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8803
Mailing Address - Country:US
Mailing Address - Phone:601-898-7530
Mailing Address - Fax:
Practice Address - Street 1:307 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2631
Practice Address - Country:US
Practice Address - Phone:662-746-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center