Provider Demographics
NPI:1235515990
Name:QUANTUMCARE MEDICAL, SPORTS & INJURY LLC
Entity Type:Organization
Organization Name:QUANTUMCARE MEDICAL, SPORTS & INJURY LLC
Other - Org Name:QUANTUMCARE SPORTS & INJURY CENTERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROA-OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-234-8900
Mailing Address - Street 1:1151 BLACKWOOD AVE. STE.170
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761
Mailing Address - Country:US
Mailing Address - Phone:321-234-8900
Mailing Address - Fax:407-930-3544
Practice Address - Street 1:1151 BLACKWOOD AVE. STE.170
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761
Practice Address - Country:US
Practice Address - Phone:321-234-8900
Practice Address - Fax:407-930-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102920207R00000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty