Provider Demographics
NPI:1629086038
Name:QUALITY CARE PEDIATRICS
Entity Type:Organization
Organization Name:QUALITY CARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-277-7860
Mailing Address - Street 1:6910 N MAIN ST
Mailing Address - Street 2:UNIT 34
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9680
Mailing Address - Country:US
Mailing Address - Phone:574-277-7860
Mailing Address - Fax:574-277-7861
Practice Address - Street 1:6910 N MAIN ST
Practice Address - Street 2:UNIT 34
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9680
Practice Address - Country:US
Practice Address - Phone:574-277-7860
Practice Address - Fax:574-277-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN21055OtherPHYSICIAN HEALTH PLAN
IN200889900Medicaid
IN200889900Medicaid