Southern Illinois Healthcare Foundation Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Collinsville, IL
NPI 1790455103 · NPPES record last updated Sep 16, 2021
Key facts
- NPI
- 1790455103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
- Practice address
- 9649 Collinsville Rd
Collinsville, IL 62234-1876 - Phone
- (618) 332-0953
- NPI assigned
- Sep 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Mr. Larry McCulley
- Title
- Ceo
- Phone
- (618) 332-0694
Corporate family (same tax ID) 37
Practitioners 3
-
James Nanney, PA-C
-
Carrie E. Parent, PA-C
-
Christina Valerio, MD, MPH
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
- Tax ID family
- Southern Illinois Hthca
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Psychiatry Physician |
2084P0800X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
9649 Collinsville Rd
Collinsville, IL 62234-1876
Mailing address
2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0953
Other names
- SIHF Healthcare
- Collinsville Middle School - School Based Health Center
Other providers in Collinsville, IL
- Michael Sly
- Stefan M Smith
- Steven Scott Smith
- Susan M Smith
- Southern Illinois Health Care Association
- Southern Illinois Healthcare Foundation, Inc.
- St. John'S Healing Community Board
- Kristin V Stahl
- Martina Renee Steed
- Elizabeth Dawn Steele
All providers in Collinsville, 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 Sep 16, 2021. 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.