Provider Demographics
NPI:1770257925
Name:JEFFERS, ORIS
Entity Type:Individual
Prefix:
First Name:ORIS
Middle Name:
Last Name:JEFFERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WILDE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3415
Mailing Address - Country:US
Mailing Address - Phone:215-554-9695
Mailing Address - Fax:
Practice Address - Street 1:504 SHARON AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-2215
Practice Address - Country:US
Practice Address - Phone:267-205-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)