Provider Demographics
NPI:1710377981
Name:MARK QUINLAN MD PC
Entity Type:Organization
Organization Name:MARK QUINLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-505-8787
Mailing Address - Street 1:16945 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2312
Mailing Address - Country:US
Mailing Address - Phone:402-505-8787
Mailing Address - Fax:402-933-0371
Practice Address - Street 1:16945 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2312
Practice Address - Country:US
Practice Address - Phone:402-505-8787
Practice Address - Fax:402-933-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty