Healthcare Provider Details

I. General information

NPI: 1902870439
Provider Name (Legal Business Name): QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E OUTER RD S STE 4
CANTON MO
63435-1702
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 573-288-5949
  • Fax: 573-288-5755
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAN EVANS
Title or Position: CEO
Credential:
Phone: 217-222-6550