Healthcare Provider Details

I. General information

NPI: 1861986549
Provider Name (Legal Business Name): QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 217-277-4070
  • Fax:
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036094428
License Number StateIL

VIII. Authorized Official

Name: PATTY WOERMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 217-222-6550