Provider Demographics
NPI:1760464499
Name:QUAD CITY NEUROSURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:QUAD CITY NEUROSURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-383-2763
Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:STE 4300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-383-2763
Mailing Address - Fax:563-328-5500
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:STE 4300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-383-2763
Practice Address - Fax:563-328-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16496Medicare ID - Type Unspecified