Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
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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