Organization
MOLINA HEALTHCARE OF WISCONSIN
Active
Parent organization
MOLINA HEALTHCARE, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOLINA HEALTHCARE, INC
Authorized official
MR. STEPHEN M HARRIS (PLAN PRESIDENT)
(414) 847-1765
Entity
Organization
Contact information
Practice address
2400 S 102ND ST, SUITE 105, WEST ALLIS, WI 53227-2132
(414) 847-1766
(414) 847-1778
Mailing address
2400 S 102ND ST, SUITE 105, WEST ALLIS, WI 53227-2132
(414) 847-1766
(414) 847-1778
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
18011
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69004600
—
WI
Enumeration date
12/17/2008
Last updated
05/18/2011
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