Healthcare Provider Details

I. General information

NPI: 1568890325
Provider Name (Legal Business Name): PEDIATRICS PLUS. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 AVENUE OF THE CITIES STE 101B SUITE 101B
MOLINE IL
61265-4454
US

IV. Provider business mailing address

4011 AVENUE OF THE CITIES STE 101B SUITE 101B
MOLINE IL
61265-4454
US

V. Phone/Fax

Practice location:
  • Phone: 309-517-6177
  • Fax: 309-517-6178
Mailing address:
  • Phone: 309-517-6177
  • Fax: 309-517-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number036095373
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036095373
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL JAMES SCHOTT
Title or Position: OWNER/SOLE PRACTIONER
Credential: M.D.
Phone: 309-517-6177