Provider Demographics
NPI:1982624987
Name:QUAD CITIES AUDIOLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:QUAD CITIES AUDIOLOGY CONSULTANTS, P.C.
Other - Org Name:AUDIOLOGY CONSULTANTS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-355-7712
Mailing Address - Street 1:2215 E. 52ND STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-7712
Mailing Address - Fax:563-359-1325
Practice Address - Street 1:2215 E 52ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2786
Practice Address - Country:US
Practice Address - Phone:563-355-7712
Practice Address - Fax:563-359-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0236745Medicaid
IA26520Medicare ID - Type Unspecified
IA0236745Medicaid