Provider Demographics
NPI:1457835076
Name:QUAD/MED, LLC
Entity Type:Organization
Organization Name:QUAD/MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:POULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-566-8400
Mailing Address - Street 1:N64W23110 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089
Mailing Address - Country:US
Mailing Address - Phone:414-566-8400
Mailing Address - Fax:
Practice Address - Street 1:1 REYNOLDS WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45430
Practice Address - Country:US
Practice Address - Phone:937-485-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care