DR. WILLIAM EDWARD MOREDOCK (NPI# 1720167026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720167026 |
| Entity Type | Individual |
| Full Name | DR. WILLIAM EDWARD MOREDOCK |
| Credential | PH.D. |
| Practice Address |
1200 W. Washington Street Springfield IL 62702-4794 |
| Mailing Address |
4100 Chandlerwood Springfield IL 62711-6081 |
| Practice Telephone | 2177871595 |
| Mailing Telephone | 2177933612 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2013-07-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071.003906 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | HEALTHLINK | 255240 | 01 |
| IL | BCBSIL | 08406629 | 01 |
| IL | MAGELLAN | 174554000 | 01 |
| IL | CAQH | 11443979 | 01 |
| Street Address |
1200 W. WASHINGTON STREET |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710509187 | Laura M Maggio | Psychologist | 11 Stephanie Cir, Springfield, MA 01129-1961 | 2020-05-08 |
| 1215556386 | Lotus Healing Center LLC | Psychologist | 28 Millburn Ave Ste 6, Springfield, NJ 07081-1023 | 2020-04-09 |
| 1194359216 | Kathrin A Koehler | Psychologist | 4674 Hominy Ridge Rd, Springfield, OH 45502-8031 | 2020-02-27 |
| 1689126120 | Assessment Consultants, LLC | Psychologist | 2146 W Chesterfield Blvd Ste E202, Springfield, MO 65807-8650 | 2016-11-01 |
| 1003366436 | Caitriona Hayes | Psychologist | 8134 Old Keene Mill Road, Suite 101, Springfield, VA 22152 | 2016-10-10 |
| 1669929907 | Richart Lipe Demier | Psychologist | 5871 S Northern Ridge Rd, Springfield, MO 65810-1976 | 2016-09-03 |
| 1043660905 | Safe Harbor Christian Counseling of Northern Virginia LLC | Psychologist | 8304 Old Keene Mill Rd, Springfield, VA 22152-1640 | 2016-06-21 |
| 1659786432 | Kimberly Wilkins Psyd LLC | Psychologist | 1344 W Oakville Rd, Springfield, MO 65810-1696 | 2014-06-30 |
| 1548507817 | Bahn and Associates | Psychologist | 3000 Professional Dr Ste D, Bahn Consulting, Inc., Springfield, IL 62703-5931 | 2013-01-07 |
| 1396004990 | Cultivate Psychological Services LLC | Psychologist | 1439 S Rogers Ave, Springfield, MO 65804-1129 | 2012-05-16 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
Please comment or provide details below to improve the information on DR. WILLIAM EDWARD MOREDOCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.