Healthcare Provider Details

I. General information

NPI: 1114912607
Provider Name (Legal Business Name): QUALITY MEDICAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S BABCOCK ST
MELBOURNE FL
32901-1459
US

IV. Provider business mailing address

675 S BABCOCK ST
MELBOURNE FL
32901-1459
US

V. Phone/Fax

Practice location:
  • Phone: 321-951-8695
  • Fax: 321-956-8937
Mailing address:
  • Phone: 321-951-1010
  • Fax: 321-952-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: SUBASH K THAREJA
Title or Position: PRESIDENT
Credential: MD
Phone: 321-951-1010