Healthcare Provider Details

I. General information

NPI: 1790079309
Provider Name (Legal Business Name): QMG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S FEDERAL HIGHWAY SUITE 401
HOLLYWOOD FL
33020-6811
US

IV. Provider business mailing address

210 S FEDERAL HIGHWAY SUITE 401
HOLLYWOOD FL
33020-6811
US

V. Phone/Fax

Practice location:
  • Phone: 954-598-9900
  • Fax: 954-929-2001
Mailing address:
  • Phone: 954-598-9900
  • Fax: 954-929-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK GRNJA
Title or Position: CEO
Credential:
Phone: 954-612-7502