Molina Healthcare of Wisconsin
NPI #1700022936 in West Allis, Wisconsin
Provider Information
- NPI Number
- 1700022936
- Entity Type
- Organization
- Organization Name
- Molina Healthcare of Wisconsin
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MOLINA HEALTHCARE, INC
- Primary Specialty
- Health Maintenance Organization
- Enumeration Date
- Dec 17, 2008
- Last Updated
- May 18, 2011
Practice Location
- Address
- 2400 S 102ND ST
- Address 2
- SUITE 105
- City
- West Allis
- State
- Wisconsin
- ZIP Code
- 53227-2132
- Phone
- (414) 847-1766
Authorized Official
- Name
- MR. STEPHEN M HARRIS
- Title
- PLAN PRESIDENT
- Phone
- (414) 847-1765
Specialties & Taxonomy Codes
| Specialty |
|---|
| Health Maintenance Organization |
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