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Riley Quinn

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669

PECOS Enrollment

Based on the most recent information from CMS, provider Riley Quinn is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:26 AM.

Profile Details

Provider ID
1538771373
Provider Type
Individual
Full Name
Quinn, Riley
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
8/22/2020
Last Updated
6/26/2023

Contact Information

Practice Location

2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669

(414) 649-7900

Unlisted Fax

Mailing Location

3301 W Forest Home Ave, Milwaukee, WI 53215-2843

1464979004

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 5161-23 Wisconsin
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 2523 Nebraska

Provider Identifiers

ID	Description	Issuer
ID 100190376	Description Medicaid	Issuer Unlisted Wisconsin

Riley Quinn

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Virk, Effett S

Irby, Shemeka

Sherry, Charnai Dawn

Bowers, Reid Christian

Vahlsing, Olivia Josephine

Rabe, Kathryn Rose

Whitehouse, Melissa Marie

Lacoursiere, Benjamin Alan

Keepers, Jacob Finer

Rongstad, Lindsey