Provider Demographics
NPI:1780853424
Name:QUARRY PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:QUARRY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-284-0700
Mailing Address - Street 1:17740 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6633
Mailing Address - Country:US
Mailing Address - Phone:734-284-0700
Mailing Address - Fax:734-284-7676
Practice Address - Street 1:17740 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6633
Practice Address - Country:US
Practice Address - Phone:734-284-0700
Practice Address - Fax:734-284-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE37600Medicare UPIN
MI1060353-11Medicare PIN