Provider Demographics
NPI:1265768451
Name:MAQUOKETA KIDNEY CENTER, LLC
Entity type:Organization
Organization Name:MAQUOKETA KIDNEY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-5570
Mailing Address - Street 1:400 JOHN DEERE RD
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6898
Mailing Address - Country:US
Mailing Address - Phone:309-762-5570
Mailing Address - Fax:309-762-5297
Practice Address - Street 1:700 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2163
Practice Address - Country:US
Practice Address - Phone:563-652-9674
Practice Address - Fax:563-652-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265768451Medicaid
IA62543OtherBCBS OF IA / WELLMARK
IA162543Medicare Oscar/Certification