MEDICARE: QS PEDS MED LLC

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	208000000X	Pediatrics Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1891426441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QS PEDS MED LLC

Provider Business Mailing Address
First Line	:	9480 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-876-7876
Fax Number	:	833-450-5867

Provider Business Practice Location Address
First Line	:	9480 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-876-7876
Fax Number	:

Authorized Official
Title or Position	:	OWNER - MEDICAL DIRECTOR
Name	:	JUSTIN PESPISA
Credential	:	MD
Telephone Number	:	405-876-7876

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	07/29/2024

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