Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Active
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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