Provider Demographics
NPI:1205402195
Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type:Organization
Organization Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Other - Org Name:QUINCY MEDICAL GROUP KAHOKA AFFILIATE
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-222-6550
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4096
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:133 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-1775
Practice Address - Country:US
Practice Address - Phone:660-727-3388
Practice Address - Fax:660-727-2196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINCY PHYSICIANS & SURGEONS CLINIC, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-01
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health