Healthcare Provider Details

I. General information

NPI: 1972704179
Provider Name (Legal Business Name): QUANTUM HEALTHCARE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N MAIN ST STE 230
HAZARD KY
41701-2503
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-2962
  • Fax: 606-436-0848
Mailing address:
  • Phone: 606-435-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CONNIE CASTLE
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 606-436-0711