Provider Demographics
NPI:1174818447
Name:QUAD CITIES PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:QUAD CITIES PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-424-2025
Mailing Address - Street 1:5510 UTICA RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2935
Mailing Address - Country:US
Mailing Address - Phone:563-424-2025
Mailing Address - Fax:563-424-2042
Practice Address - Street 1:5510 UTICA RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2935
Practice Address - Country:US
Practice Address - Phone:563-424-2025
Practice Address - Fax:563-424-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32037261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4225250Medicaid
IA4225250Medicaid
IAG59880Medicare UPIN