Healthcare Provider Details

I. General information

NPI: 1174886311
Provider Name (Legal Business Name): QUANTUM IMAGING HOLDINGS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 12TH AVE SUITE 102
POMPANO BEACH FL
33069-3298
US

IV. Provider business mailing address

2221 N UNIVERSITY DR SUITE A
PEMBROKE PINES FL
33024-3603
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-1180
  • Fax: 954-786-1189
Mailing address:
  • Phone: 954-985-6490
  • Fax: 954-985-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN ADAM BURACK
Title or Position: OWNER
Credential: D.O
Phone: 954-985-6490