Provider Demographics
NPI:1770872566
Name:QUALCARE MEDICAL CENTERS LLC
Entity type:Organization
Organization Name:QUALCARE MEDICAL CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
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:954-929-3449
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0042
Practice Address - Street 1:790 IVES DAIRY RD OP-5 WEST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2425
Practice Address - Country:US
Practice Address - Phone:305-405-0365
Practice Address - Fax:305-405-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty