Provider Demographics
NPI:1821412636
Name:QUALITY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:QUALITY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:916-784-1050
Mailing Address - Street 1:151 N SUNRISE AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2924
Mailing Address - Country:US
Mailing Address - Phone:916-784-1050
Mailing Address - Fax:916-784-1989
Practice Address - Street 1:151 N SUNRISE AVE STE 611
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2926
Practice Address - Country:US
Practice Address - Phone:916-784-1050
Practice Address - Fax:916-784-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27635106H00000X
CAMFC38009106H00000X
CAG22928208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty