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General NPI Number Information
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NPI Number | 1861986549
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Entity Type | Organization
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Legal Business Name | QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 3301 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3713
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Country | US
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Telephone | 217-277-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 MAINE ST
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City | QUINCY
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State | IL
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Zip | 62301-4038
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Country | US
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Telephone | 217-222-6550
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | PATTY WOERMAN
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Credential |
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Telephone | 217-222-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036094428
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License Number State | IL
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