Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Organization
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
Active
Other names
ESL School Based Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MCCULLEY (CEO)
(618) 332-0694
Entity
Organization
Contact information
Practice address
3939 CASEYVILLE AVE, EAST SAINT LOUIS, IL 62204-2448
(618) 482-4562
(618) 482-4930
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
—
IL
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LS0200X
School Nurse Practitioner
—
—
Other
Enumeration date
12/26/2006
Last updated
02/25/2013
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