Healthcare Provider Details

I. General information

NPI: 1053856039
Provider Name (Legal Business Name): QMG3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 BRIDGEPORT AVE
SHELTON CT
06824-5484
US

IV. Provider business mailing address

201 WHITES HILL LN
FAIRFIELD CT
06484-2177
US

V. Phone/Fax

Practice location:
  • Phone: 203-567-4171
  • Fax: 203-567-4172
Mailing address:
  • Phone: 203-567-4171
  • Fax: 203-567-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: STEVEN HEFFER
Title or Position: CHEIF MEDICAL OFFICER
Credential: M.D.
Phone: 203-567-4171