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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