1669532172 NPI number — QUINN MILLER GROUP INC

Table of content: (NPI 1669532172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669532172 NPI number — QUINN MILLER GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUINN MILLER GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MED CARE
Provider Other Organization Name Type Code:
3
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:
1669532172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 RUTHAR DR
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-8029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-738-9742
Provider Business Mailing Address Fax Number:
302-738-4863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 RUTHAR DR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711-8029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-738-9742
Provider Business Practice Location Address Fax Number:
302-738-4863
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-738-9742

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2005200246 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 2005200246 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 522026MED . This is a "BCBS DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 000122916 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003890 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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