Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Active
Other names
Windsor Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (PRESIDENT)
(618) 332-0783
Entity
Organization
Contact information
Practice address
100 N 8TH ST, EAST ST LOUIS, IL 62201-2989
(618) 274-9105
(618) 274-9101
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
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
732740
WPS MEDICARE
IL
Enumeration date
06/23/2006
Last updated
07/29/2009
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