Provider Demographics
NPI:1235249756
Name:MORELAND AND DEVITT, INC
Entity Type:Organization
Organization Name:MORELAND AND DEVITT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-322-3333
Mailing Address - Street 1:124 N CONGRESS ST
Mailing Address - Street 2:PO BOX 319
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1434
Mailing Address - Country:US
Mailing Address - Phone:217-322-3333
Mailing Address - Fax:217-322-6817
Practice Address - Street 1:124 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1434
Practice Address - Country:US
Practice Address - Phone:217-322-3333
Practice Address - Fax:217-322-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54007553333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0253920001OtherMEDICARE RAILROAD
IL=========001Medicaid
IL=========001Medicaid