Provider Demographics
NPI:1346236742
Name:JENNIFER C QUIMBY MD INC PS
Entity Type:Organization
Organization Name:JENNIFER C QUIMBY MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:QUIMBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-307-7202
Mailing Address - Street 1:9750 LEVIN RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8399
Mailing Address - Country:US
Mailing Address - Phone:360-307-7202
Mailing Address - Fax:360-698-6600
Practice Address - Street 1:9750 LEVIN RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8399
Practice Address - Country:US
Practice Address - Phone:360-307-7202
Practice Address - Fax:360-698-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119775Medicaid
WAH58307Medicare UPIN
WA1119775Medicaid