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?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3085110Medicaid
OH9382691Medicare PIN