Provider Demographics
NPI:1881081255
Name:QUALITY OF LIFE ON-SITE PHYSICIANS SERVICES, LLC
Entity type:Organization
Organization Name:QUALITY OF LIFE ON-SITE PHYSICIANS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-560-8953
Mailing Address - Street 1:2007 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1532
Mailing Address - Country:US
Mailing Address - Phone:813-763-8741
Mailing Address - Fax:813-333-7408
Practice Address - Street 1:2007 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1532
Practice Address - Country:US
Practice Address - Phone:813-763-8741
Practice Address - Fax:813-333-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty