MEDICARE: QUANTUM HEALTH PRACTICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
2	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1497299085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUANTUM HEALTH PRACTICE, LLC

Provider Business Mailing Address
First Line	:	505 YORK RD
Second Line	:	SUITE 7A
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2136
Country	:	US
Telephone Number	:	267-626-2334
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 YORK RD
Second Line	:	SUITE 7A
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2136
Country	:	US
Telephone Number	:	267-626-2334
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CHRISTINE CAMPLING
Credential	:
Telephone Number	:	610-931-1217

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	01/11/2017

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