Individual ProviderJohn William MolitorNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3009 N Ballas Rd, Suite 323a, Saint Louis, MO 63131-2322(314) 942-2213PECOS EnrollmentBased on the most recent information from CMS, provider John William Molitor does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1255878054Provider TypeIndividualFull NameMolitor, John WilliamCredentialAGACNPGenderMaleSole ProprietorNoEnumeration Date1/31/2017Last Updated3/16/2021Contact InformationPractice LocationPractice Address3009 N Ballas Rd, Suite 323a, Saint Louis, MO 63131-2322Phone(314) 942-2213Fax(314) 942-2217Mailing LocationMailing Address3009 N Ballas Rd Ste 323a, Saint Louis, MO 63131-2324Phone(314) 942-2213Fax(314) 942-2217Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense2012010001Missouri