Healthcare Provider Details

I. General information

NPI: 1407330871
Provider Name (Legal Business Name): PRECEDENCE CARE COORDINATION ENTITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 3RD ST
MOLINE IL
61265-6106
US

IV. Provider business mailing address

4600 3RD ST
MOLINE IL
61265-6106
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-3200
  • Fax:
Mailing address:
  • Phone: 309-779-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LINDSEY TIFFENBACK
Title or Position: MANAGER SUPPORT SERVICES
Credential: RHIA
Phone: 309-714-0246