Provider Demographics
NPI:1114747060
Name:QUALITY CARE PARTNERS LLC
Entity type:Organization
Organization Name:QUALITY CARE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSN APRN CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:863-221-2351
Mailing Address - Street 1:5789 CORDOVA RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:IL
Mailing Address - Zip Code:61250-9740
Mailing Address - Country:US
Mailing Address - Phone:863-221-2351
Mailing Address - Fax:
Practice Address - Street 1:5789 CORDOVA RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:IL
Practice Address - Zip Code:61250-9740
Practice Address - Country:US
Practice Address - Phone:863-221-2351
Practice Address - Fax:309-515-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty