Provider Demographics
NPI:1295973030
Name:3C, P.C.
Entity type:Organization
Organization Name:3C, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-788-7522
Mailing Address - Street 1:2525 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5395
Mailing Address - Country:US
Mailing Address - Phone:309-788-7522
Mailing Address - Fax:
Practice Address - Street 1:2525 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5395
Practice Address - Country:US
Practice Address - Phone:309-788-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103632207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103632Medicaid
ILF94000Medicare UPIN
IL036103632Medicaid
ILP00719682Medicare PIN