Southern Illinois Healthcare Foundation, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Madison, IL
NPI 1255514717 · NPPES record last updated Apr 20, 2008
Key facts
- NPI
- 1255514717
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
- Practice address
- 308 Madison Ave
Madison, IL 62060-1110 - Phone
- (618) 397-3303
- Fax
- (618) 397-7802
- NPI assigned
- Dec 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Larry McCulley
- Title
- Coo
- Phone
- (618) 332-0694
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031126000641 | IL | Part B Supplier - Clinic/Group Practice | 1456256874 |
Receives reassigned benefits from 170 practitioners This NPI is an additional NPI on the enrollment Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
308 Madison Ave
Madison, IL 62060-1110
Mailing address
8080 State St
East Saint Louis, IL 62203-1808
Phone (618) 397-3303
Other names
- Madison Health Center
Other providers in Madison, IL
- Granite City Clinic Corp
- Jason F. Kesselring
- Madison County Urban League
- Real RN Recruiter
- Rachelle Russell
- Southern Illinois Healthcare Foundation, Inc.
- Southern Illinois Healthcare Foundation, Inc.
- Stay at Home Health Care Inc
- Renee M Titley
All providers in Madison, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.