Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Other names
Alton Women's Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (PRESIDENT)
(618) 332-0783
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR, SUITE 122, ALTON, IL 62002-6723
(618) 465-2550
(618) 465-4167
Mailing address
8080 STATE ST, EAST SAINT LOUIS, IL 62203-1808
(618) 397-3303
(618) 397-7802
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Enumeration date
06/23/2006
Last updated
07/29/2009
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