Provider Demographics
NPI:1861681306
Name:ASTHMA ALLERGY CLINIC OF QUAD CITIES, S.C
Entity Type:Organization
Organization Name:ASTHMA ALLERGY CLINIC OF QUAD CITIES, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VELAGAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-764-5900
Mailing Address - Street 1:525 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-764-5900
Mailing Address - Fax:309-764-5926
Practice Address - Street 1:525 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-764-5900
Practice Address - Fax:309-764-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17064Medicare PIN