Provider Demographics
NPI:1245218411
Name:QUAD CITY ENDOSCOPY, L.L.C.
Entity Type:Organization
Organization Name:QUAD CITY ENDOSCOPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SREENIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINTALAPANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-277-5624
Mailing Address - Street 1:4340 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6867
Mailing Address - Country:US
Mailing Address - Phone:309-277-5624
Mailing Address - Fax:309-277-9201
Practice Address - Street 1:4340 7TH STREET
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6867
Practice Address - Country:US
Practice Address - Phone:309-277-5624
Practice Address - Fax:309-277-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003125261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50139OtherBCBS OF IL
IA96644OtherBCBS OF IA
IL50139OtherBCBS OF IL
IA96644OtherBCBS OF IA