MEDICARE: WILLIAM M. QUIRK, M.D., FACOG, OBSTETRICS AND GYNECOLOGY, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	35063544	OH
2	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023347499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM M. QUIRK, M.D., FACOG, OBSTETRICS AND GYNECOLOGY, LLC.

Provider Business Mailing Address
First Line	:	5533 MAHONING AVE
Second Line	:	SUITE D
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2366
Country	:	US
Telephone Number	:	330-793-7966
Fax Number	:	330-953-3963

Provider Business Practice Location Address
First Line	:	5533 MAHONING AVE
Second Line	:	SUITE D
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-2366
Country	:	US
Telephone Number	:	330-793-7966
Fax Number	:	330-953-3963

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELISSA QUIRK
Credential	:
Telephone Number	:	330-793-7699

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	09/22/2014

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