Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Central Alton Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
2615 EDWARDS ST, ALTON, IL 62002-3915
(618) 462-4342
(618) 462-5334
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
(618) 332-2487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141142
MEDICARE
IL
Enumeration date
11/05/2010
Last updated
08/02/2011
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