Provider Demographics
NPI:1003216391
Name:QMC LLC
Entity type:Organization
Organization Name:QMC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-710-9178
Mailing Address - Street 1:PO BOX 7411190
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-1190
Mailing Address - Country:US
Mailing Address - Phone:305-554-7000
Mailing Address - Fax:305-554-1775
Practice Address - Street 1:5201 BLUE LAGOON DR FL 89
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2064
Practice Address - Country:US
Practice Address - Phone:305-554-1700
Practice Address - Fax:305-554-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100221500Medicaid
FL013698000Medicaid