Provider Demographics
NPI:1487612024
Name:QUAD CITY AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:QUAD CITY AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-1952
Mailing Address - Street 1:520 VALLEY VIEW DRIVE
Mailing Address - Street 2:STE #300
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-762-1952
Mailing Address - Fax:309-762-6075
Practice Address - Street 1:520 VALLEY VIEW DRIVE
Practice Address - Street 2:STE #300
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-762-1952
Practice Address - Fax:309-762-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
92304OtherBCIA
50034OtherBCIL
92304OtherBCIA
50034OtherBCIL