Provider Demographics
NPI:1306960943
Name:QUANTUM LLC
Entity type:Organization
Organization Name:QUANTUM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BARBISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-598-8213
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:STE 301
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1022
Mailing Address - Country:US
Mailing Address - Phone:719-955-1237
Mailing Address - Fax:
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:STE 301
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1022
Practice Address - Country:US
Practice Address - Phone:719-955-1237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73733334Medicaid
CO73733334Medicaid