Basic Information
| Provider Information | |||||||||
| NPI: | 1255603619 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUANTUM HEALTHCARE ASSOCIATES OF CUMBERLAND, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 KINGDOM COME DR | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 408231590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065895514 | ||||||||
| FaxNumber: | 6065895909 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 KINGDOM COME DR | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 408231590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065895514 | ||||||||
| FaxNumber: | 6065895909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2012 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6065895514 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | 900254 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.