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NPI Code Detail

MEDICARE: KENT S QUINN MD

MEDICARE: KENT S QUINN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085B0100XBody Imaging Physician21181IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083609184
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENT S QUINN MD
Provider Business Mailing Address
First Line : PO BOX 66971
Second Line : DEPT MR
City : SAINT LOUIS
State : MO
Zip : 63166-6971
Country : US
Telephone Number : 303-465-0401
Fax Number : 303-438-1351
Provider Business Practice Location Address
First Line : 1 GOOD SAMARITAN WAY
Second Line : ATTN RADIOLOGY DEPT
City : MOUNT VERNON
State : IL
Zip : 62864-2402
Country : US
Telephone Number : 618-242-4600
Fax Number : 618-242-4600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 07/05/2016

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