Provider Demographics
NPI:1245992957
Name:THOJ, POBTSUAS
Entity type:Individual
Prefix:
First Name:POBTSUAS
Middle Name:
Last Name:THOJ
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 1:4330 NAKOOSA TRL APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1354
Mailing Address - Country:US
Mailing Address - Phone:608-572-2516
Mailing Address - Fax:
Practice Address - Street 1:4330 NAKOOSA TRL APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1354
Practice Address - Country:US
Practice Address - Phone:608-572-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI555-555-55551OtherNONE
WINONEOtherNONE