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NPI Code Detail

MEDICARE: QUANTUM IMAGING HOLDINGS, LLC

MEDICARE: QUANTUM IMAGING HOLDINGS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/CenterFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OS9851OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1720342827
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUANTUM IMAGING HOLDINGS, LLC
Provider Business Mailing Address
First Line : 2221 N UNIVERSITY DR STE A
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33024-3603
Country : US
Telephone Number : 954-985-6490
Fax Number : 954-985-6491
Provider Business Practice Location Address
First Line : 4560 LANTANA RD
Second Line : SUITE A
City : LAKE WORTH
State : FL
Zip : 33463-6998
Country : US
Telephone Number : 954-985-6490
Fax Number : 954-985-6491
Authorized Official
Title or Position : OWNER
Name : DR. STEVEN ADAM BURACK
Credential : D.O.
Telephone Number : 954-985-6490
Provider Enumeration Date : 07/03/2012
Last Update Date : 07/03/2012

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