MEDICARE: MONTANO QUALITY OF GUARANTEED SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1841163433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANO QUALITY OF GUARANTEED SERVICES CORP

Provider Business Mailing Address
First Line	:	2190 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5326
Country	:	US
Telephone Number	:	305-803-1412
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAUL L ZIMMERMAN
Credential	:	MD
Telephone Number	:	305-803-1412

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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