Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
State Street Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CHIEF OPERATING OFFICER)
(618) 332-0783
Entity
Organization
Contact information
Practice address
2001 STATE ST, EAST SAINT LOUIS, IL 62205-1803
(618) 271-9191
(618) 271-9617
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
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/02/2007
Last updated
10/30/2008
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