Provider Demographics
NPI:1891872552
Name:QUAD CITY HELICOPTER EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:QUAD CITY HELICOPTER EMERGENCY MEDICAL SERVICE
Other - Org Name:MED-FORCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAKACS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-529-3823
Mailing Address - Street 1:1820 GRANT ST PMB 5027
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4927
Mailing Address - Country:US
Mailing Address - Phone:563-529-3823
Mailing Address - Fax:563-355-3370
Practice Address - Street 1:6343 WOLF RD
Practice Address - Street 2:
Practice Address - City:COLONA
Practice Address - State:IL
Practice Address - Zip Code:61241-8963
Practice Address - Country:US
Practice Address - Phone:309-796-0373
Practice Address - Fax:309-796-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2 2518013416A0800X
IL2 2518023416A0800X
IA80017013416A0800X
IA82917003416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24000OtherBLUE CROSS OF IOWA
IA0222737Medicaid
IL03732004OtherBLUE CROSS OF IL
IL03732004OtherBLUE CROSS OF IL
IA0222737Medicaid
IAI0796Medicare ID - Type UnspecifiedMEDICARE