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

Christian Activity Health Center

Practice address

540 N 6TH St
East Saint Louis, IL 62201-1320

Phone

(618) 397-3303

Fax

(618) 397-3303

NPI assigned

Sep 19, 2008

Last updated

Sep 19, 2008By 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

Coo

Phone

(618) 332-0694

Specialties & licenses 2

Addresses

Other names 1

• Christian Activity Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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

{
    "created_epoch": "1221782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1619127289",
    "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": "540 N 6TH ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622011320",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-19",
        "last_updated": "2008-09-19",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "618-332-0694",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Activity Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Scheer, NP
• Bharat Kantilal Shah, M.D.
• Tierra Q Smith, FNP-BC
• Southern Illinois Health Care Foundation, Inc. (SIHF Healthcare)
• Southern Illinois Health Care Foundation, Inc. (Comprehensive Health Center)
• Southern Illinois Healthcare Foundation, Inc. (Quick Care I Center)
• Southern Illinois Healthcare Foundation, Inc. (Adult Care Center)
• Southern Illinois Healthcare Foundation, Inc. (SIHF Healthcare)
• Southern Illinois Healthcare Foundation, Inc. (Fairmont City Health Center)
• Southern Illinois Healthcare Foundation, Inc. (Windsor Health Center II)

• Federally Qualified Health Center (FQHC) in East Saint Louis, IL
• Providers in East Saint Louis, 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 Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.