Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Other names
Millstadt Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
60 REGENCY PL, MILLSTADT, IL 62260-2210
(618) 476-9177
(618) 476-1890
Mailing address
2041 GOOSE LAKE RD, SAUGET, IL 62206-2822
(618) 332-0953
(618) 332-2487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
IL
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Enumeration date
02/01/2013
Last updated
02/01/2013
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