Provider Demographics
NPI:1215925805
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 1:4730 44TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-283-0880
Practice Address - Fax:309-283-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-09
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
131131100OtherUS DEPT OF LABOR
MO623820305Medicaid
IL0008170232OtherBLUE CROSS BLUE SHIELD
IA0933150Medicaid
WI41788300Medicaid
IA44119OtherWELLMARK BLUE CROSS
IA0933150Medicaid
WI41788300Medicaid