Provider Demographics
NPI:1821500042
Name:QCPI-VILLAGEMD, PC
Entity Type:Organization
Organization Name:QCPI-VILLAGEMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBAS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:312-465-7898
Mailing Address - Street 1:1 N FRANKLIN STREET
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:847-264-5585
Mailing Address - Fax:
Practice Address - Street 1:3445 PEACHTREE RD NE STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3251
Practice Address - Country:US
Practice Address - Phone:678-553-4603
Practice Address - Fax:470-387-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79130207Q00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty