Provider Demographics
NPI:1730288556
Name:FAMILY HEALTH PARTNERS OF THE QUAD CITIES, PC
Entity Type:Organization
Organization Name:FAMILY HEALTH PARTNERS OF THE QUAD CITIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-441-5860
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-441-5860
Mailing Address - Fax:563-441-5865
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-441-5860
Practice Address - Fax:563-441-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0256800Medicaid
I5524Medicare ID - Type Unspecified
IA0256800Medicaid