Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
Children's Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
2810 FRANK SCOTT PKWY W, BELLEVILLE, IL 62223-5007
(618) 236-6336
(618) 236-9582
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
(618) 332-2487
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/21/2011
Last updated
08/02/2011
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