Provider Demographics
NPI:1295700805
Name:PULMONARY ASSOCIATES OF QC PC
Entity type:Organization
Organization Name:PULMONARY ASSOCIATES OF QC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKSHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHADEVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-323-1352
Mailing Address - Street 1:3385 DEXTER CT STE 102
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-323-1352
Mailing Address - Fax:855-274-1654
Practice Address - Street 1:3385 DEXTER CT STE 102
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-323-1352
Practice Address - Fax:855-274-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCE8561OtherRAILROAD MEDICARE
IA0138016Medicaid
IADB8111OtherRAILROAD MEDICARE
ILCE8561OtherRAILROAD MEDICARE
IA07739Medicare ID - Type Unspecified