Provider Demographics
NPI:1023347499
Name:WILLIAM M. QUIRK, M.D., FACOG, OBSTETRICS AND GYNECOLOGY, LLC.
Entity type:Organization
Organization Name:WILLIAM M. QUIRK, M.D., FACOG, OBSTETRICS AND GYNECOLOGY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-793-7699
Mailing Address - Street 1:5533 MAHONING AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2366
Mailing Address - Country:US
Mailing Address - Phone:330-793-7966
Mailing Address - Fax:330-953-3963
Practice Address - Street 1:5533 MAHONING AVE
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2366
Practice Address - Country:US
Practice Address - Phone:330-793-7966
Practice Address - Fax:330-953-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063544207VF0040X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107026Medicaid
OH3034451Medicaid
OHWI9387091Medicare PIN
OHF63682Medicare UPIN