Provider Demographics
NPI:1790410215
Name:MOLITOR, JEFFREY JAMES (MOLITOR TRANSPORT LL)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAMES
Last Name:MOLITOR
Suffix:
Gender:M
Credentials:MOLITOR TRANSPORT LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W178 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:WI
Mailing Address - Zip Code:54425-9421
Mailing Address - Country:US
Mailing Address - Phone:715-965-7398
Mailing Address - Fax:
Practice Address - Street 1:W178 HICKORY RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:WI
Practice Address - Zip Code:54425-9421
Practice Address - Country:US
Practice Address - Phone:715-965-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)