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General NPI Number Information
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NPI Number | 1154130870
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Entity Type | Organization
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Legal Business Name | QUANTUM MEDICAL GROUP LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1040 EDGEWATER CORPORATE PKWY
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City | INDIAN LAND
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State | SC
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Zip | 29707-4514
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Country | US
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Telephone | 704-763-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 EDGEWATER CORPORATE PKWY
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City | INDIAN LAND
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State | SC
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Zip | 29707-4514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | AMIT SHAH
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Credential |
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Telephone | 704-763-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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