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General NPI Number Information
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NPI Number | 1003930629
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Entity Type | Organization
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Legal Business Name | LINDA K. SIMONS
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 117 N 6TH ST
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City | QUINCY
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State | IL
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Zip | 62301-2903
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Country | US
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Telephone | 217-223-8791
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Fax | 217-223-8791
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Provider Business Mailing Address
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Address Line | 117 N 6TH ST
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City | QUINCY
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State | IL
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Zip | 62301-2903
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Country | US
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Telephone | 217-223-8791
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Fax | 217-223-8791
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LINDA K SIMONS
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Credential | CFM
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Telephone | 217-223-8791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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