Provider Demographics
NPI:1972704179
Name:QUANTUM HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:QUANTUM HEALTHCARE ASSOCIATES INC
Other - Org Name:QUANTUM HEALTHCARE ASSOCIATES, PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-0711
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0959
Mailing Address - Country:US
Mailing Address - Phone:606-435-2961
Mailing Address - Fax:
Practice Address - Street 1:1908 N MAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2503
Practice Address - Country:US
Practice Address - Phone:606-435-2962
Practice Address - Fax:606-436-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100101180Medicaid
KY000000527699OtherANTHEM
KY7100016150Medicaid
KY183871Medicare Oscar/Certification
KY00467Medicare PIN