Provider Demographics
NPI:1194058123
Name:QUAD CITY PROSTHETIC INC
Entity type:Organization
Organization Name:QUAD CITY PROSTHETIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:309-676-2276
Mailing Address - Street 1:741 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1953
Mailing Address - Country:US
Mailing Address - Phone:800-334-5705
Mailing Address - Fax:888-663-6322
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:STE 500
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-6435
Practice Address - Fax:309-277-0042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUAD CITY PROSTHETIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0250150002Medicare NSC