Organization
MAQUOKETA KIDNEY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJESH ALLA M.D. (MEDICAL DIRECTOR)
(309) 762-5570
Entity
Organization
Contact information
Practice address
700 W GROVE ST, MAQUOKETA, IA 52060-2163
(563) 652-9674
(563) 652-9679
Mailing address
400 JOHN DEERE RD, MOLINE, IL 61265-6898
(309) 762-5570
(309) 762-5297
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265768451
—
IA
01
—
62543
BCBS OF IA / WELLMARK
IA
Enumeration date
10/23/2009
Last updated
08/29/2014
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