Provider Demographics
NPI:1336103795
Name:QUAD CITIES PATHOLOGISTS, LLC
Entity Type:Organization
Organization Name:QUAD CITIES PATHOLOGISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:BILLMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-8555
Mailing Address - Street 1:1520 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2917
Mailing Address - Country:US
Mailing Address - Phone:309-762-8555
Mailing Address - Fax:563-326-0115
Practice Address - Street 1:1520 7TH STREET
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2917
Practice Address - Country:US
Practice Address - Phone:309-762-8555
Practice Address - Fax:563-326-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZC0500X
14D1019160207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB0382OtherRAILROAD PROVIDER #
IA0418822Medicaid
DC1096OtherRAILROAD PROVIDER #
IA0418822Medicaid
IAI10884Medicare PIN
IAI10884Medicare PIN
IA=========002Medicaid