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MOULTRIE CO
NPI 1538213285
Public Health or Welfare in Sullivan, IL

Active since January 22, 2007CLIA Certified · 2 labs
202 S MAIN ST, SULLIVAN, IL 61951(217) 728-4114(217) 728-2650 Get Directions Write a Review

NPPES record last updated: December 8, 2014. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Moultrie Co NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOULTRIE CO (NPI 1538213285) is a healthcare organization registered as a public health or welfare in Sullivan, Illinois and active in the NPI registry since January 2007. The organization holds 2 active CLIA laboratory certificates and lists Angela L. Hogan, Administrator, as its authorized official.

NPPES Registry Identity

NPI1538213285
Entity TypeOrganization
Primary Taxonomy251K00000X
Legal Business NameMOULTRIE CO
Location Address202 S MAIN STSullivan, IL 61951-1958
Mailing Address202 S Main StSullivan, IL 61951-1958 · (217) 728-4114 · Fax (217) 728-2650
Phone(217) 728-4114
Fax(217) 728-2650
Organization SubpartNo
Authorized OfficialAngela L. HoganAdministrator · (217) 728-4114
Enumeration DateJanuary 22, 2007
Last NPPES UpdateDecember 8, 2014
✔ NPI 1538213285 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPublic Health or WelfareAgencies
Taxonomy Code251K00000X
202 S MAIN ST, Sullivan, IL 61951
Open in Google Maps ↗

Other Identifiers 2

Medicare ID-Type Unspecified623420IL
Medicaid240000139001IL

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0973071

Moultrie County Health Department · Sullivan, IL
Active · expires Apr 24, 2028
CLIA Number14D0973071
Laboratory TypeOther
Certificate Effective DateApril 25, 2026
Certificate Expiration DateApril 24, 2028
Laboratory DirectorAngela L. Hogan
Laboratory Phone(217) 728-4114
Laboratory LocationMoultrie County Health Department202 S Main St, Sullivan, IL 61951
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2164020

Moultrie Co Detention Center · Sullivan, IL
Active · expires Mar 25, 2027
CLIA Number14D2164020
Laboratory TypeCounty
Certificate Effective DateMarch 26, 2025
Certificate Expiration DateMarch 25, 2027
Laboratory DirectorJodi R. Trussell
Laboratory Phone(217) 728-4386
Laboratory LocationMoultrie Co Detention Center1505 W Hagerman Rd, Sullivan, IL 61951
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
127 services126 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
107 services106 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moultrie Co's NPI number?

The NPI number for Moultrie Co is 1538213285. It was assigned to this organization in the NPPES registry on January 22, 2007.

Where is Moultrie Co located?

Moultrie Co is located at 202 S Main St, Sullivan, IL 61951. The listed phone number is (217) 728-4114.

What is Moultrie Co's specialty?

The primary specialty registered for this NPI is Public Health or Welfare with taxonomy code 251K00000X.

Does Moultrie Co hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Moultrie Co was last updated on December 8, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.