Provider Demographics
NPI:1174795769
Name:QUILLIN FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:QUILLIN FAMILY MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:QUILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-342-4660
Mailing Address - Street 1:909 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2815
Mailing Address - Country:US
Mailing Address - Phone:541-342-4660
Mailing Address - Fax:541-344-5127
Practice Address - Street 1:909 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2815
Practice Address - Country:US
Practice Address - Phone:541-342-4660
Practice Address - Fax:541-344-5127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUILLIN FAMILY MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130892Medicare PIN
ORR130893Medicare PIN
F65078Medicare UPIN