1144215740 NPI number — DR. STEVEN P QUINN DDS

Table of content: DR. STEVEN P QUINN DDS (NPI 1144215740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144215740 NPI number — DR. STEVEN P QUINN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINN
Provider First Name:
STEVEN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144215740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1103 E MONTCLAIR ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-5076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-887-8800
Provider Business Mailing Address Fax Number:
417-887-6265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 E MONTCLAIR ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-887-8800
Provider Business Practice Location Address Fax Number:
417-887-6265
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  0145654 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15376 . This is a "BC/S MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19000578 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 882645 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11245 . This is a "BC/S DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14564 . This is a "DELTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15376 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14564 . This is a "DELTA TRICARE" identifier . This identifiers is of the category "OTHER".




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