Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Active
Other names
Centreville 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
6000 BOND AVE, CENTREVILLE, IL 62207-2328
(618) 332-2740
(618) 332-8755
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
(618) 397-7802
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/31/2006
Last updated
05/26/2016
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