Provider Demographics
NPI:1356315899
Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type:Organization
Organization Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Other - Org Name:QUINCY MEDICAL GROUP PITTSFIELD AFFILIATE
Other - Org Type:Doing Business As
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 1:320 NORTH MADISON
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1412
Mailing Address - Country:US
Mailing Address - Phone:217-285-9601
Mailing Address - Fax:
Practice Address - Street 1:320 NORTH MADISON
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1412
Practice Address - Country:US
Practice Address - Phone:217-285-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
143885Medicare Oscar/Certification
14-3885Medicare ID - Type Unspecified