Provider Demographics
NPI:1447307954
Name:QUINCY INTERMED INC
Entity type:Organization
Organization Name:QUINCY INTERMED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-639-5354
Mailing Address - Street 1:185 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MI
Mailing Address - Zip Code:49082-1165
Mailing Address - Country:US
Mailing Address - Phone:517-639-5354
Mailing Address - Fax:
Practice Address - Street 1:185 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MI
Practice Address - Zip Code:49082-1165
Practice Address - Country:US
Practice Address - Phone:517-639-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty