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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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