Provider Demographics
NPI:1104837384
Name:QUANTUM FAMILY CARE, P.A.
Entity Type:Organization
Organization Name:QUANTUM FAMILY CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FILIPPO
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-484-1887
Mailing Address - Street 1:3303 COLORADO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6812
Mailing Address - Country:US
Mailing Address - Phone:940-484-1887
Mailing Address - Fax:940-591-0458
Practice Address - Street 1:3303 COLORADO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6815
Practice Address - Country:US
Practice Address - Phone:940-484-1887
Practice Address - Fax:940-591-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080942801Medicaid
TX122082402OtherMEDICAID INDIVIDUAL PROVIDER NUMBER
TX080942801Medicaid