Organization
SIUPHYSICIANS & SURGEONS, INC.
Active
Other names
SIU QUINCY FAMILY PRACTICE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NELSON C WEICHOLD (C.F.O.)
(217) 545-7578
Entity
Organization
Contact information
Practice address
612 N 11TH ST, QUINCY, IL 62301-2662
(217) 224-9484
(217) 224-7894
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB2589
RR MEDICARE
IL
01
—
CE8686
RR MEDICARE
IL
01
—
CE8687
RR MEDICARE
IL
01
—
CE8688
RR MEDICARE
IL
01
—
CE8689
RR MEDICARE
IL
01
—
CE8931
RR MEDICARE
IL
Enumeration date
06/17/2006
Last updated
12/03/2014
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