Provider Demographics
NPI:1679007561
Name:T.J. MORE, INC
Entity Type:Organization
Organization Name:T.J. MORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DENSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-791-6921
Mailing Address - Street 1:2313 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3826
Mailing Address - Country:US
Mailing Address - Phone:773-791-6921
Mailing Address - Fax:
Practice Address - Street 1:2743 W CONGRESS PKWY
Practice Address - Street 2:APT 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3485
Practice Address - Country:US
Practice Address - Phone:773-791-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD52580090075343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)