Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Vandalia Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CHIEF OPERATIONS OFFICER)
(618) 332-0783
Entity
Organization
Contact information
Practice address
727 W JACKSON ST, VANDALIA, IL 62471-1722
(618) 283-3144
(618) 283-3194
Mailing address
8080 STATE ST, EAST SAINT LOUIS, IL 62203-1808
(618) 397-3303
(618) 397-7802
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine 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
03/05/2009
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