1356345946 NPI number — METROPOLITAN MEDICAL LABORATORY, PLC

Table of content: (NPI 1356345946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356345946 NPI number — METROPOLITAN MEDICAL LABORATORY, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN MEDICAL LABORATORY, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
QUAD CITIES PATHOLOGISTS GROUP
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356345946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1814 E LOCUST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52803-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-324-0471
Provider Business Mailing Address Fax Number:
563-326-0115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-762-8555
Provider Business Practice Location Address Fax Number:
563-326-0115
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BILLMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
309-762-8555

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  14D0430746 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 690002426 . This is a "RAILROAD PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002394 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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