# COMMONWEALTH QUALITY MEDICAL MANAGEMENT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609177021
- **Authorized official:** SUSAN JUSTICE (CO-OWNER)
- **Authorized official phone:** (606) 769-6824

## Contact information

- **Practice address:** 387 EDGEWOOD LN, PRESTONSBURG, KY 41653-9196
- **Practice address phone:** (606) 769-6824
- **Practice address fax:** (606) 769-0086
- **Mailing address:** PO BOX 1747, PRESTONSBURG, KY 41653-5747
- **Mailing address phone:** (606) 769-6824
- **Mailing address fax:** (606) 769-0086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/17/2010
- **Last updated:** 11/17/2010