Provider Demographics
NPI:1780288753
Name:QUALITY MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:QUALITY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:YISU
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-240-1805
Mailing Address - Street 1:3604 GALLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4301
Mailing Address - Country:US
Mailing Address - Phone:719-638-4548
Mailing Address - Fax:
Practice Address - Street 1:3604 GALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4301
Practice Address - Country:US
Practice Address - Phone:719-638-4548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty