Provider Demographics
NPI:1578639126
Name:HEMATOLOGY-ONCOLOGY ASSOCIATES OF THE QUAD CITIES, PC
Entity Type:Organization
Organization Name:HEMATOLOGY-ONCOLOGY ASSOCIATES OF THE QUAD CITIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, OCN
Authorized Official - Phone:563-355-7733
Mailing Address - Street 1:1351 KIMBERLY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4193
Mailing Address - Country:US
Mailing Address - Phone:563-355-7733
Mailing Address - Fax:563-355-9077
Practice Address - Street 1:1351 KIMBERLY RD
Practice Address - Street 2:STE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4193
Practice Address - Country:US
Practice Address - Phone:563-355-7733
Practice Address - Fax:563-355-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0110700Medicaid
IA0110700Medicaid
IA1005990001Medicare NSC