Organization
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK R FREELAND (EXECUTIVE DIRECTOR)
(618) 874-3120
Entity
Organization
Contact information
Practice address
1736 KINGSHIGHWAY, EAST SAINT LOUIS, IL 62204-2134
(618) 874-3120
(618) 215-4048
Mailing address
1736 KINGSHIGHWAY, EAST SAINT LOUIS, IL 62204-2134
(618) 874-3120
(618) 215-4048
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/30/2006
Last updated
07/06/2016
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