Provider Demographics
NPI:1548547946
Name:SCRANTON QUINCY CLINIC COMPANY LLC
Entity type:Organization
Organization Name:SCRANTON QUINCY CLINIC COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:THORN
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9812
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:877-309-5312
Mailing Address - Fax:615-465-2877
Practice Address - Street 1:521 MT PLEASANT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1987
Practice Address - Country:US
Practice Address - Phone:570-346-7338
Practice Address - Fax:570-341-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102669377-0004Medicaid
PA102669377-0004Medicaid