Provider Demographics
NPI:1548734403
Name:QC DISTRICT MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:QC DISTRICT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINOO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-7800
Mailing Address - Street 1:1450 W GUADALUPE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3056
Mailing Address - Country:US
Mailing Address - Phone:480-926-7800
Mailing Address - Fax:480-926-2260
Practice Address - Street 1:21323 S ELLSWORTH LOOP RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9865
Practice Address - Country:US
Practice Address - Phone:480-839-8552
Practice Address - Fax:480-926-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty