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General NPI Number Information
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NPI Number | 1710966205
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Entity Type | Organization
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Legal Business Name | QUAD CITY CLINIC SC
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 4322 7TH ST
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City | MOLINE
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State | IL
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Zip | 61265-6867
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Country | US
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Telephone | 309-762-5501
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Fax | 309-762-7434
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Provider Business Mailing Address
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Address Line | 4322 7TH ST
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City | MOLINE
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State | IL
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Zip | 61265-6867
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Country | US
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Telephone | 309-762-5501
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Fax | 309-762-7434
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC A ALFON
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Credential | MD
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Telephone | 309-762-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IN
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