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General NPI Number Information
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NPI Number | 1679007561
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Entity Type | Organization
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Legal Business Name | T.J. MORE, INC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 2743 W CONGRESS PKWY APT 1W
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City | CHICAGO
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State | IL
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Zip | 60612-3485
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Country | US
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Telephone | 773-791-6921
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 S 25TH AVE
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City | BROADVIEW
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State | IL
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Zip | 60155-3826
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Country | US
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Telephone | 773-791-6921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TREVOR JEROME DENSMORE
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Credential |
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Telephone | 773-791-6921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | D52580090075
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License Number State | IL
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