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General NPI Number Information
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NPI Number | 1780288753
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Entity Type | Organization
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Legal Business Name | QUALITY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 3604 GALLEY RD STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-4301
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Country | US
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Telephone | 719-638-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 GALLEY RD STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-4301
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Country | US
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Telephone | 719-638-4548
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | JASON YISU PARK
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Credential | DPT
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Telephone | 720-240-1805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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