NPIMap

Organization Active NPI

Quality Medical Clinic, LLC

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1780288753
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
QUALITY MEDICAL CLINIC, LLC
Practice address
3604 Galley Rd Ste 201
Colorado Springs, CO 80909-4301
Phone
(719) 638-4548
NPI assigned
Nov 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason Yisu Park, DPTNPI 1447458369
Title
Ceo/ President
Phone
(720) 240-1805

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

3604 Galley Rd Ste 201
Colorado Springs, CO 80909-4301

Mailing address

3604 Galley Rd Ste 201
Colorado Springs, CO 80909-4301
Phone (719) 638-4548

National Provider Directory

National Provider Directory

Locations

3604 Galley Rd
Ste 201
Colorado Springs, CO 80909
Phone (719) 634-4548

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1780288753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 GALLEY RD STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094301",
            "telephone_number": "719-638-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 GALLEY RD STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094301",
            "telephone_number": "719-638-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "YISU",
        "authorized_official_title_or_position": "CEO/ PRESIDENT",
        "authorized_official_telephone_number": "720-240-1805",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.