1396877205 NPI number — QUINCO CONSULTING CENTER INC

Table of content: (NPI 1396877205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396877205 NPI number — QUINCO CONSULTING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUINCO CONSULTING CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1396877205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 N BEVCHER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-265-6444
Provider Business Practice Location Address Fax Number:
812-265-6444
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-314-3400

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000209001 . This is a "ANTHEM GROUP PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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