MOULTRIE CO NPI 1538213285

NPI Information

  • NPI: 1538213285
  • Provider Name: MOULTRIE CO
  • Classification: Public Health or Welfare - 251K00000X
  • Entity Type: Organization
  • CLIA Number: 14D0973071
  • Address: 202 S MAIN ST
    SULLIVAN, IL
    ZIP 61951
  • Phone: (217) 728-4114

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NPI Details

MOULTRIE CO is a public health or welfare in Sullivan, IL. MOULTRIE CO NPI is 1538213285. The provider is registered as an organization entity type.

The provider's business location address is:

202 S MAIN ST
SULLIVAN, IL
ZIP 61951-958
Phone: (217) 728-4114
Fax: (217) 728-2650

The provider's authorized official is Angela L. Hogan .
The authorized official title is Administrator and has the following contact phone number (217) 728-4114.

The CLIA number assigned to this NPI record is 14D0973071 - other with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)

The enumeration date for this NPI number is 1/22/2007 and was last updated on 12/8/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251K00000XPublic Health or WelfareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1623420MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
2240000139001MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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