Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Salem Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CHIEF OPERATING OFFICER)
(618) 332-0783
Entity
Organization
Contact information
Practice address
1275 HAWTHORN RD, SALEM, IL 62881-1028
(618) 548-4545
(618) 548-4577
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
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201518
WPS MEDICARE GROUP NUMBER
IL
Enumeration date
06/18/2006
Last updated
04/20/2008
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