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1415 Vermont St Quincy IL 62301-3119 | |
| (217) 224-4453 | |
| (217) 224-9383 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1415 Vermont St, Quincy, Illinois |
| Authorized Official Name and Position | Timothy A Moore (CAO) |
| Authorized Official Contact | 2172231200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1005 Broadway St Quincy IL 62301-2834 Ph: (217) 224-4453 | 1415 Vermont St Quincy IL 62301-3119 Ph: (217) 224-4453 |
| NPI Number | 1649574336 |
|---|---|
| Provider Enumeration Date | 01/10/2011 |
| Last Update Date | 11/27/2023 |
| Certification Date | 03/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649574336 | NPI | - | NPPES |
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