Southern Illinois Healthcare Foundation Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Arthur, IL
NPI 1508301706 · NPPES record last updated Dec 23, 2022
Key facts
- NPI
- 1508301706
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
- Practice address
- 1710 State Route 133
Arthur, IL 61911 - Phone
- (217) 543-2446
- Fax
- (217) 543-2548
- NPI assigned
- Dec 23, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Larry McCulley
- Title
- Ceo
- Phone
- (618) 973-6229
Corporate family (same tax ID) 37
Practitioners 3
-
Oladele O. Ajao, MD
-
Brittany Wright, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Federally qualified health center certification: CCN 781873
- Legal name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
- Doing business as
- SIHF HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 25, 2017
- Last certification
- Apr 25, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 27, 1985 in IL
- Enrollment address
- 1710 State Route 133
Arthur, IL 61911-1130
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Percy McKinney |
Corporate Director |
Apr 22, 2024 | |
| Walter Hunter |
Corporate Officer |
Mar 1, 2008 | |
| Gerard Hasenstab |
Corporate Director |
Jan 1, 2019 | |
| Dale Fiedler |
Corporate Director |
Jan 1, 2020 | |
| Debra Reed |
Corporate Director |
Jan 1, 2021 | |
| Larry W McCulley |
Corporate Officer |
Feb 1, 2011 | |
| Kenneth Hall |
Corporate Director |
Jan 1, 2019 | |
| Zoila Marty |
Corporate Director |
Sep 1, 2005 | |
| Ethel Manager |
Corporate Officer |
May 1, 1996 | |
| Crysten Calvert |
Corporate Officer |
Jan 1, 2025 | |
| Daniel Winkle |
W-2 Managing Employee | May 1, 2025 | |
| Anna Marie Nelson |
Corporate Director |
Jan 1, 2010 | |
| Richard Sinclair |
Corporate Director |
Jul 1, 2006 | |
| Darrel Sterling |
Corporate Director |
Jan 1, 2023 | |
| Irma Golliday |
Corporate Director |
Aug 1, 1999 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Touchette Regional Hospital Inc |
Hospital | Operational/Managerial Control | Jun 30, 2009 |
| Touchette Regional Hospital Inc |
Hospital | Operational/Managerial Control | Jun 30, 2009 |
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… |
| O20170425000282 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 1456256874 | Practice locations: Arthur, IL |
National Provider Directory
- Tax ID family
- Southern Illinois Hthca
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | IL | ||
| Clinical Social Worker |
1041C0700X | IL | ||
| Family Medicine Physician |
207Q00000X | IL | ||
| Internal Medicine Physician |
207R00000X | IL | ||
| Pediatrics Physician |
208000000X | IL | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | IL | Yes |
Addresses
Primary practice location
1710 State Route 133
Arthur, IL 61911
Mailing address
2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0694
Other practice location 1
525 N Vine St
Arthur, IL 61911-1130
Phone (618) 332-0694
Other names
- SIHF Healthcare
- SIHF Healthcare - Arthur
Other providers in Arthur, IL
- Radical Roots Clinic LLC
- Reed Pharmacies, LLC
- Miriam Ricsi-Perez
- John Mark Schrock
- Jessica Smith
- Shawna L Storm
- Jameia C Tyler
- William H Shackelford MD
- Willow Tree Wellness Center LLC
- Dolores Josephine Wilson
All providers in Arthur, 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 Dec 23, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.