Provider Demographics
NPI:1578542155
Name:QUAD CITY PULMONARY CONSULTANTS PLC
Entity Type:Organization
Organization Name:QUAD CITY PULMONARY CONSULTANTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRUYNTJENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-445-8000
Mailing Address - Street 1:1230 E RUSHOLME ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2400
Mailing Address - Country:US
Mailing Address - Phone:563-445-8000
Mailing Address - Fax:563-324-7531
Practice Address - Street 1:1230 E RUSHOLME ST STE 105
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2400
Practice Address - Country:US
Practice Address - Phone:563-445-8000
Practice Address - Fax:563-324-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28605207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7086132Medicaid
IAI14090Medicare PIN
DC5560Medicare PIN