Impact Community Services LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IMPACT COMMUNITY SERVICES LLC

Practice address

202 E 5900 S
Salt Lake City, UT 84107-7330

Phone

(385) 775-0777

NPI assigned

Oct 24, 2025

Organization subpart

No

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

Authorized official

Name

Jazzamin Clark

Title

Manager

Phone

(385) 775-0777

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1761264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1952279762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E 5900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841077330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E 5900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841077330",
            "telephone_number": "385-775-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COMMUNITY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-24",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JAZZAMIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "385-775-0777"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.