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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