Provider Demographics
NPI:1578536603
Name:IRVING, PATRCIK (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRCIK
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-5000
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5351
Practice Address - Country:US
Practice Address - Phone:309-779-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01541207P00000X
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101OtherJOHN DEERE
IAP00002829OtherRR MEDICARE
94002OtherBCWELLMARK 7TH
35073OtherBCWELLMARK TP
50516OtherIHS TP
94051OtherBCWELLMARK WEST
IA2148452Medicaid
ILK23832Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ILLIN
IAP00002829OtherRR MEDICARE
94002OtherBCWELLMARK 7TH