Healthcare Provider Details

I. General information

NPI: 1528032059
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

105 E QUINCY ST
LEWISTOWN MO
63452-2560
US

IV. Provider business mailing address

105 E QUINCY ST
LEWISTOWN MO
63452-2560
US

V. Phone/Fax

Practice location:
  • Phone: 573-215-2715
  • Fax:
Mailing address:
  • Phone: 573-215-2715
  • 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: PATTY WOERMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 217-222-6550