1477968964 NPI number — QUANTUM HEALTH SOLUTIONS OF FLORIDA, INC.

Table of content: (NPI 1477968964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477968964 NPI number — QUANTUM HEALTH SOLUTIONS OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUANTUM HEALTH SOLUTIONS OF FLORIDA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477968964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4873 PALM COAST PKWY NW
Provider Second Line Business Mailing Address:
UNIT 3
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32137-3668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-300-4800
Provider Business Mailing Address Fax Number:
973-300-4816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3398 N OCEANSHORE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLAGLER BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32136-2773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-708-0333
Provider Business Practice Location Address Fax Number:
973-300-4816
Provider Enumeration Date:
06/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RICCIO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-300-4800

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  0718AD0185301 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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