Provider Demographics
NPI:1841454394
Name:NORRIS CLINIC PC
Entity type:Organization
Organization Name:NORRIS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:217-224-6900
Mailing Address - Street 1:1205 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3117
Mailing Address - Country:US
Mailing Address - Phone:217-224-6900
Mailing Address - Fax:217-224-6992
Practice Address - Street 1:1205 VERMONT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3117
Practice Address - Country:US
Practice Address - Phone:217-224-6900
Practice Address - Fax:217-224-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003842261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038003842Medicaid
IL612560Medicare PIN
ILT37244Medicare UPIN