MEDICARE: QUINCO CONSULTING CENTER INC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000209001	OTHER	IN	ANTHEM GROUP PIN

General Provider Information

NPI Number	:	1689705527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUINCO CONSULTING CENTER INC

Provider Business Mailing Address
First Line	:	720 N MARR RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6660
Country	:	US
Telephone Number	:	812-314-3400
Fax Number	:	812-378-8367

Provider Business Practice Location Address
First Line	:	2650 FOXPOINTE DRIVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-2605
Country	:	US
Telephone Number	:	812-372-5517
Fax Number	:	812-372-5518

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROBERT WILLIAMS
Credential	:	PHD, HSPP
Telephone Number	:	812-314-3400

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	08/22/2020

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