Provider Demographics
NPI:1275122640
Name:TRICE, QUAMIIR RYSHI
Entity Type:Individual
Prefix:
First Name:QUAMIIR
Middle Name:RYSHI
Last Name:TRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 N NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2919
Mailing Address - Country:US
Mailing Address - Phone:267-844-6369
Mailing Address - Fax:
Practice Address - Street 1:5927 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-2919
Practice Address - Country:US
Practice Address - Phone:267-844-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA46903601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA84-4077889Medicaid