Provider Demographics
NPI:1285140038
Name:QUALITY HEALTH CLINIC, PROF. LLC
Entity type:Organization
Organization Name:QUALITY HEALTH CLINIC, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:PROMES
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, MSN
Authorized Official - Phone:605-689-2273
Mailing Address - Street 1:2001 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2032
Mailing Address - Country:US
Mailing Address - Phone:605-689-2273
Mailing Address - Fax:605-689-0393
Practice Address - Street 1:2001 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2032
Practice Address - Country:US
Practice Address - Phone:605-689-2273
Practice Address - Fax:605-689-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001160261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service