Healthcare Provider Details

I. General information

NPI: 1770872566
Provider Name (Legal Business Name): QUALCARE MEDICAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 IVES DAIRY RD OP-5 WEST
MIAMI FL
33179-2425
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 101
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 305-405-0365
  • Fax: 305-405-0370
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-799-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHCC6244
License Number StateFL

VIII. Authorized Official

Name: MARK GRNJA
Title or Position: CFO
Credential:
Phone: 954-929-3449