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Individual

MR. SCOTT E STOUT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LNHA

Contact information

Practice address
410 NW 3RD ST, CASEY, IL 62420-1014
(217) 932-4081
(217) 932-4922
Mailing address
215 E LOCUST ST, HARRISBURG, IL 62946-1504
(618) 294-8696
(618) 294-8699

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0002923
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14E422
MEDICAID ICF/DD CERTIFICATION
IL
Enumeration date
01/11/2019
Last updated
01/11/2019
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