Provider Demographics
NPI:1396362315
Name:QUALCARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:QUALCARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRNJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-929-3400
Mailing Address - Street 1:210 S FEDERAL HWY STE 403
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-929-3400
Mailing Address - Fax:
Practice Address - Street 1:9822 TAPESTRY PARK CIR STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9260
Practice Address - Country:US
Practice Address - Phone:954-927-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALCARE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)