Provider Demographics
NPI:1831668169
Name:JOHN QUINN
Entity Type:Organization
Organization Name:JOHN QUINN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-630-9295
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-0498
Mailing Address - Country:US
Mailing Address - Phone:417-630-9295
Mailing Address - Fax:417-630-0190
Practice Address - Street 1:104 E MADISON ST STE 8
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2135
Practice Address - Country:US
Practice Address - Phone:417-630-9295
Practice Address - Fax:417-630-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)