Moore Family Stores Inc.
Organization Active NPI Community/Retail Pharmacy · Martinsville, IL
NPI 1295810422 · NPPES record last updated Jun 2, 2022
Key facts
- NPI
- 1295810422
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054020327 (IL)
- Legal business name
- MOORE FAMILY STORES INC.
- Practice address
- 890 E Ridgelawn Rd
Martinsville, IL 62442-2551 - Phone
- (217) 382-4004
- Fax
- (217) 382-3476
- NPI assigned
- Oct 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Trent Moore
- Title
- Owner/President
- Phone
- (217) 362-6226
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Moore Family Stores Inc |
Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Seat Lift Mechanisms|Walkers|Wheelchair Seating/Cushions|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100811000759 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 8921132051 |
13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Nokomis, IL; Robinson, IL; Tuscola, IL; Virden, IL |
| O20171208001049 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 0345507802 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Casey, IL; Effingham, IL; Martinsville, IL; Neoga, IL; Toledo, IL |
| O20180509000974 | IL | DME Supplier - Pharmacy | 0345507802 | Practice locations: Martinsville, IL |
National Provider Directory
- Tax ID family
- Moore Family Stores Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 054020327 | IL | Yes |
Addresses
Primary practice location
890 E Ridgelawn Rd
Martinsville, IL 62442-2551
Mailing address
2245 W Mound Rd
Decatur, IL 62526-9367
Phone (217) 362-6226
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2136610 | Other | PK |
Other names
- Martinsville Pharmacy
Other providers in Martinsville, IL
- Leslie Hearn
- Jessica Dawn Lee
- Jami L. Martin
- Martinsville Comm Unit School Dist 3
- Martinsville Family Chiropractic Clinic LTD
- Rachel K Morrison
- Valerie Marie Mullen
- Foster Dale Propst
- Denise Reed
- John Jackson Richards
All providers in Martinsville, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.