Southern Illinois Healthcare Foundation, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Doing business as

Vandalia Health Center

Practice address

727 W Jackson St
Vandalia, IL 62471-1722

Phone

(618) 283-3144

Fax

(618) 283-3194

NPI assigned

Jun 18, 2006

Last updated

Mar 5, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Larry McCulley

Title

Chief Operations Officer

Phone

(618) 332-0783

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Vandalia Health Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518902006. Details of each certification follow.

• CCN 141918 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 141918

Legal name

SOUTHERN ILLINOIS HEALTHCARE FOUNDATIO

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 13, 2001

Last certification

Aug 13, 2001

Ownership / control type

For profit – partnership

Facility address

727 N Jackson Street
Vandalia, IL 62471

Related CCNs

141832

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1518902006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031808",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 W JACKSON ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711722",
            "telephone_number": "618-283-3144",
            "fax_number": "618-283-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "618-332-0783",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS MEDICARE GROUP NUMBER",
            "identifier": "201518",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vandalia Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber Michelle Smith, MS, LCPC
• Kimberly J Snow
• Joseph J Solan, D.C.
• Jonathan Michael Sones, D.M.D
• Southern Illinois Healthcare Foundation, Inc. (SIHF Healthcare)
• Lucinda M Spencer, APRN, FNP-C
• St. Mary's Hospital
• Stay Home Caregivers, LLC
• Chad E Storck, D.C.
• Stride Nutrition and Lifestyle Services LLC

• Federally Qualified Health Center (FQHC) in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.