Healthcare Provider Details

I. General information

NPI: 1366465213
Provider Name (Legal Business Name): PRIMARY CARE PHYSICIANS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E LAKE CTR SUITE 1
QUINCY IL
62305-5842
US

IV. Provider business mailing address

3701 E LAKE CTR SUITE 1
QUINCY IL
62305-5842
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-3935
  • Fax:
Mailing address:
  • Phone: 217-224-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TERRY WILLIAM SHAW
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 217-224-3935