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General NPI Number Information
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NPI Number | 1083609184
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Entity Type | Individual
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Provider Name | KENT S QUINN MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 1 GOOD SAMARITAN WAY ATTN RADIOLOGY DEPT
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2402
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Country | US
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Telephone | 618-242-4600
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Fax | 618-242-4600
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Provider Business Mailing Address
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Address Line | PO BOX 66971 DEPT MR
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City | SAINT LOUIS
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State | MO
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Zip | 63166-6971
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Country | US
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Telephone | 303-465-0401
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Fax | 303-438-1351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 21181
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License Number State | IA
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