1578542155 NPI number — QUAD CITY PULMONARY CONSULTANTS PLC

Table of content: (NPI 1578542155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578542155 NPI number — QUAD CITY PULMONARY CONSULTANTS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUAD CITY PULMONARY CONSULTANTS 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:
Provider Other Organization Name Type Code:
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:
1578542155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 E RUSHOLME ST STE 105
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:
52803-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-445-8000
Provider Business Mailing Address Fax Number:
563-324-7531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 E RUSHOLME ST STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52803-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-445-8000
Provider Business Practice Location Address Fax Number:
563-324-7531
Provider Enumeration Date:
01/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRUYNTJENS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
563-445-8000

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  28605 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7086132 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".