Provider Demographics
NPI:1851356232
Name:NEELY & QUATRO, PSC
Entity Type:Organization
Organization Name:NEELY & QUATRO, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:T
Authorized Official - Last Name:QUATRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-821-6818
Mailing Address - Street 1:444 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2871
Mailing Address - Country:US
Mailing Address - Phone:270-821-6818
Mailing Address - Fax:270-824-6606
Practice Address - Street 1:444 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2871
Practice Address - Country:US
Practice Address - Phone:270-821-6818
Practice Address - Fax:270-824-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940017Medicaid
KY65940017Medicaid