Basic Information
| Provider Information | |||||||||
| NPI: | 1770872566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALCARE MEDICAL CENTERS LLC | ||||||||
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| OtherOrganizationName: | CALIFORNIA CLUB MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3527990042 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 IVES DAIRY RD OP-5 WEST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331792425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054050365 | ||||||||
| FaxNumber: | 3054050370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 10/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRNJA | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9549293449 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | HCC6244 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.