GORANTLA GOVINDAIAH M.D. S.C. NPI 1023222502

NPI Information

  • NPI: 1023222502
  • Provider Name: GORANTLA GOVINDAIAH, M.D., S.C.
  • Classification: Clinic/Center - 261QH0100X
  • Specialization: Health Service
  • Entity Type: Organization
  • Address: 4366 KENNEDY DR
    SUITE B
    EAST MOLINE, IL
    ZIP 61244
  • Phone: (309) 796-1510

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NPI Details

GORANTLA GOVINDAIAH, M.D., S.C. is a health service clinic center in East Moline, IL. GORANTLA GOVINDAIAH, M.D., S.C. NPI is 1023222502. The provider is registered as an organization entity type.

The provider's business location address is:

4366 KENNEDY DR
SUITE B
EAST MOLINE, IL
ZIP 61244-288
Phone: (309) 796-1510
Fax: (309) 796-1565

The provider's authorized official is Gorantla Govindaiah .
The authorized official title is Owner and has the following contact phone number (309) 796-1510.

The enumeration date for this NPI number is 5/10/2007 and was last updated on 5/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QH0100XClinic/CenterHealth ServiceYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
198669OTHERIOWAWELLMARK BCBS
2C38530MEDICARE UPINILLINOIS
3010063712OTHERRR MEDICARE
4036049003MEDICAIDILLINOIS
5263500OTHERILLINOISMEDICARE GROUP
68100279OTHERILLINOISBCBS
7K44585OTHERILLINOISMEDICARE INDIVIDUAL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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