Healthcare Provider Details

I. General information

NPI: 1700084332
Provider Name (Legal Business Name): QUALITY CAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 S MAIN ST SUITE 6
FOND DU LAC WI
54935-5739
US

IV. Provider business mailing address

757 S MAIN ST SUITE 6
FOND DU LAC WI
54935-5739
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-8888
  • Fax: 920-322-0303
Mailing address:
  • Phone: 920-929-8888
  • Fax: 920-322-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateWI

VIII. Authorized Official

Name: CHRISTINE ANN INGALLS
Title or Position: OWNER
Credential:
Phone: 920-929-8888