Provider Demographics
NPI:1932920071
Name:QUAD CITY PROSTHETIC INC
Entity type:Organization
Organization Name:QUAD CITY PROSTHETIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MICKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-285-7752
Mailing Address - Street 1:741 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1953
Mailing Address - Country:US
Mailing Address - Phone:309-285-7752
Mailing Address - Fax:309-285-7752
Practice Address - Street 1:2105 INGERSOLL AVE STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5201
Practice Address - Country:US
Practice Address - Phone:515-671-2326
Practice Address - Fax:515-381-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier