Provider Demographics
NPI: | 1578799136 |
---|---|
Name: | VILLAGE OF QUAKER CITY |
Entity Type: | Organization |
Organization Name: | VILLAGE OF QUAKER CITY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FISCAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRANDY |
Authorized Official - Middle Name: | N |
Authorized Official - Last Name: | FULST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 740-679-2609 |
Mailing Address - Street 1: | PO BOX 326 |
Mailing Address - Street 2: | |
Mailing Address - City: | QUAKER CITY |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43773-0326 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-679-2609 |
Mailing Address - Fax: | 740-679-2345 |
Practice Address - Street 1: | 126 FAIR STREET |
Practice Address - Street 2: | |
Practice Address - City: | QUAKER CITY |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43773-0326 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-679-2609 |
Practice Address - Fax: | 740-679-2345 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-06-09 |
Last Update Date: | 2023-06-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3416L0300X | Transportation Services | Ambulance | Land Transport |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 3085110 | Medicaid | |
OH | 9382691 | Medicare PIN |