Full Name | |
---|---|
Speciality | Clinic/center |
Location | 2350 41st St, Moline, Illinois |
Authorized Official Name and Position | Mark G Rogers (VICE PRESIDENT OF FINANCE) |
Authorized Official Contact | 5634216513 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2350 41st St Moline IL 61265-5014 Ph: (309) 764-1880 | 2350 41st St Moline IL 61265-5014 Ph: (309) 764-1880 |
NPI Number | 1538110218 |
---|---|
Provider Enumeration Date | 05/15/2006 |
Last Update Date | 03/01/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538110218 | NPI | - | NPPES |
96945 | Other | IL | BS GROUP # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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