Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Other names
West Belleville Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CHIEF EXECUTIVE OFFICER)
(618) 332-0694
Entity
Organization
Contact information
Practice address
7210 W MAIN ST, BELLEVILLE, IL 62223-3038
(618) 394-0712
(618) 394-1346
Mailing address
8080 STATE ST, EAST SAINT LOUIS, IL 62203-1808
(618) 397-3303
(618) 397-7802
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
732740
WPS MEDICARE GROUP NUMBER
IL
Enumeration date
06/30/2006
Last updated
11/03/2011
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