Provider Demographics
NPI:1558515551
Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type:Organization
Organization Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Other - Org Name:QUINCY MEDICAL GROUP
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 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:231 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1027
Practice Address - Country:US
Practice Address - Phone:217-742-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-8919Medicare PIN