MEDICARE: QUALITY SUPPORT SOLUTIONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency		UT

General Provider Information

NPI Number	:	1699869263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY SUPPORT SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	966 SOUTH 400 EAST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4342
Country	:	US
Telephone Number	:	801-575-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	966 SOUTH 400 EAST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4342
Country	:	US
Telephone Number	:	801-575-5484
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KANNIKA DAMRONGSIRI
Credential	:	M.P.A.
Telephone Number	:	801-575-5484

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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