Provider Demographics
NPI:1063794188
Name:JAI SWAMINARAYAN INC
Entity type:Organization
Organization Name:JAI SWAMINARAYAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BHRANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KURANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-650-7135
Mailing Address - Street 1:4350 7TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6890
Mailing Address - Country:US
Mailing Address - Phone:309-517-1180
Mailing Address - Fax:309-517-1113
Practice Address - Street 1:4350 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6890
Practice Address - Country:US
Practice Address - Phone:309-517-1180
Practice Address - Fax:309-517-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDS4198OtherRR MEDICARE PTAN
ILDS4198OtherRR MEDICARE PTAN
ILIL6251Medicare PIN