Provider Demographics
NPI:1740349034
Name:QUAD CITIES NEPHROLOGY ASSOCIATES, P.L.C., LLC
Entity type:Organization
Organization Name:QUAD CITIES NEPHROLOGY ASSOCIATES, P.L.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESWARARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-517-3036
Mailing Address - Street 1:400 JOHN DEERE RD BLDG 1
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:309-517-3036
Mailing Address - Fax:309-797-1088
Practice Address - Street 1:400 JOHN DEERE RD BLDG 1
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6898
Practice Address - Country:US
Practice Address - Phone:309-517-3036
Practice Address - Fax:309-797-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056049Medicaid
IA0510917Medicaid
IL036103114Medicaid
IL036114547Medicaid
IL08100343OtherBCBS ILLINOIS
IL036088655Medicaid
IL08100343OtherBCBS IL
IA93122OtherWELLMARK ILLINOIS
IA93122OtherWELLMARK
ILDG2517OtherRR GP RA ONLY
IA0175471Medicaid
IA56266OtherWELLMARK
IA0175471Medicaid
IA56266Medicare PIN
IAIB1568Medicare PIN
IA56266OtherWELLMARK
IA93122OtherWELLMARK
IL036114547Medicaid
IL036103114Medicaid