Provider Demographics
NPI:1619972445
Name:QUINCY MEDICAL CENTER
Entity Type:Organization
Organization Name:QUINCY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-376-5730
Mailing Address - Street 1:114 WHITWELL ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:617-773-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2222006730OtherBLUE CROSS SDC
MA1010417Medicaid
MA1212575Medicaid
MA905705OtherTUFTSHEALTHCARE INPT
MACR00016OtherBLUE CROSS CARDIAC REHAB
MA2222006701OtherBLUE CROSS INPT.
MA2222006710OtherBLUE CROSS OP
MA905706OtherTUFTS HEALTHCARE OP
MA2222006710OtherBLUE CROSS OP
MA2222006701OtherBLUE CROSS INPT.
MA225618Medicare ID - Type UnspecifiedMEDICARE TCU