Healthcare Provider Details

I. General information

NPI: 1245218411
Provider Name (Legal Business Name): QUAD CITY ENDOSCOPY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 7TH STREET
MOLINE IL
61265-6867
US

IV. Provider business mailing address

4340 7TH STREET
MOLINE IL
61265-6867
US

V. Phone/Fax

Practice location:
  • Phone: 309-277-5624
  • Fax: 309-277-9201
Mailing address:
  • Phone: 309-277-5624
  • Fax: 309-277-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7003125
License Number StateIL

VIII. Authorized Official

Name: DR. SREENIVAS CHINTALAPANI
Title or Position: ADMINISTRATOR MEDICAL DIRECTOR
Credential: MD
Phone: 309-277-5624