Healthcare Provider Details

I. General information

NPI: 1518198662
Provider Name (Legal Business Name): QUAD CITY PROSTHETIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N VAN BUREN AVE
FREEPORT IL
61032-4223
US

IV. Provider business mailing address

741 W MAIN ST
PEORIA IL
61606-1953
US

V. Phone/Fax

Practice location:
  • Phone: 815-266-2074
  • Fax: 815-266-2075
Mailing address:
  • Phone: 800-334-5705
  • Fax: 888-663-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. AMIT BHANTI
Title or Position: CEO
Credential: CPO
Phone: 309-676-2276