Provider Demographics
NPI:1790079309
Name:QMG, LLC
Entity Type:Organization
Organization Name:QMG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:954-612-7502
Mailing Address - Street 1:210 S FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-598-9900
Mailing Address - Fax:954-929-2001
Practice Address - Street 1:210 S FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 401
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:954-598-9900
Practice Address - Fax:954-929-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272884202Medicaid