| Southern Il Regional Wellness Center | |
|
1736 Kingshighway Washington Park IL 62204-2135 | |
| (618) 482-7922 | |
| (618) 215-4048 |
| Full Name | Southern Il Regional Wellness Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1736 Kingshighway, Washington Park, Illinois |
| Authorized Official Name and Position | Mark Freeland (CEO) |
| Authorized Official Contact | 6184827922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Il Regional Wellness Center 1736 Kingshighway Washington Park IL 62204-2135 Ph: (618) 482-7922 | Southern Il Regional Wellness Center 1736 Kingshighway Washington Park IL 62204-2135 Ph: (618) 482-7922 |
| NPI Number | 1295194009 |
|---|---|
| Provider Enumeration Date | 02/22/2016 |
| Last Update Date | 05/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295194009 | NPI | - | NPPES |
| 1336258540 | Other | IL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Southern Illinois Regional Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1835 Kingshighway, Washington Park, IL 62204 Phone: 618-482-7922 Fax: 618-482-7881 |