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General NPI Number Information
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NPI Number | 1821693060
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Entity Type | Individual
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Provider Name | QUENTEN EDWARD AUSTIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2611 S BANKER ST
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City | EFFINGHAM
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State | IL
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Zip | 62401-2980
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Country | US
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Telephone | 217-347-3303
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 S LAKE DR
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City | VANDALIA
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State | IL
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Zip | 62471-3807
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Country | US
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Telephone | 618-792-3440
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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