Provider Demographics
NPI:1821103920
Name:QUINN HEALTHCARE,PLLC
Entity Type:Organization
Organization Name:QUINN HEALTHCARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-487-6482
Mailing Address - Street 1:768 AVERY BLVD N
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5219
Mailing Address - Country:US
Mailing Address - Phone:601-487-6482
Mailing Address - Fax:601-487-6528
Practice Address - Street 1:768 AVERY BLVD N
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5219
Practice Address - Country:US
Practice Address - Phone:601-487-6482
Practice Address - Fax:601-487-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09458077Medicaid
MSC02901Medicare ID - Type Unspecified