| Southern Illinois Healthcare Foundation, Inc | |
|
5900 Bond Ave Centreville IL 62207-2326 | |
| (618) 332-0953 | |
| (618) 332-2487 |
| Full Name | Southern Illinois Healthcare Foundation, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 5900 Bond Ave, Centreville, Illinois |
| Authorized Official Name and Position | Larry Mcculley (CEO) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Healthcare Foundation, Inc 2041 Goose Lake Rd Sauget IL 62206-2822 Ph: (618) 332-0953 | Southern Illinois Healthcare Foundation, Inc 5900 Bond Ave Centreville IL 62207-2326 Ph: (618) 332-0953 |
| NPI Number | 1538449509 |
|---|---|
| Provider Enumeration Date | 08/23/2011 |
| Last Update Date | 08/23/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538449509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
Southern Illinois Healthcare Foundation Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6000 Bond Ave, Centreville, IL 62207 Phone: 618-332-2740 |