Provider Demographics
NPI:1598966640
Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type:Organization
Organization Name:QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Other - Org Name:QUINCY MEDICAL GROUP MT. STERLING 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 1:216 PITTSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1403
Mailing Address - Country:US
Mailing Address - Phone:217-773-3963
Mailing Address - Fax:
Practice Address - Street 1:216 PITTSFIELD RD
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1403
Practice Address - Country:US
Practice Address - Phone:217-773-3963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid