| Quincy Medical Group Canton Affiliate | |
|
1100 E Outer Rd S Ste 4 Canton MO 63435-1702 | |
| (573) 288-5949 | |
| (573) 288-5755 |
| Full Name | Quincy Medical Group Canton Affiliate |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 E Outer Rd S Ste 4, Canton, Missouri |
| Authorized Official Name and Position | Dan Evans (CEO) |
| Authorized Official Contact | 2172226550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Quincy Medical Group Canton Affiliate 1025 Maine St Quincy IL 62301-4038 Ph: (217) 222-6550 | Quincy Medical Group Canton Affiliate 1100 E Outer Rd S Ste 4 Canton MO 63435-1702 Ph: (573) 288-5949 |
| NPI Number | 1902870439 |
|---|---|
| Provider Enumeration Date | 02/13/2006 |
| Last Update Date | 12/20/2021 |
| Medicare PECOS PAC ID | 0749192375 |
|---|---|
| Medicare Enrollment ID | O20101105000872 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902870439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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