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

SIHF PSR CLUB HOUSE FACILITY

Practice address

2057 Edison Ave
Suite a
Granite City, IL 62040-4514

Phone

(618) 397-3303

Fax

(618) 397-7802

NPI assigned

Oct 29, 2007

Organization subpart

No

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

Authorized official

Name

Miss Larry McCulley

Title

Coo

Phone

(618) 332-0694

Specialties & licenses 3

Addresses

Other names 1

• SIHF PSR CLUB HOUSE FACILITY Doing business as

Locations

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1821277658",
    "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": "2057 EDISON AVE",
            "address_2": "SUITE A",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404514",
            "telephone_number": "618-397-3303",
            "fax_number": "618-397-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2007-10-29",
        "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": "Miss"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIHF PSR CLUB HOUSE FACILITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southern Illinois Healthcare Foundation, Inc
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Healthcare Foundation, Inc.
• Southern Illinois Histology, LLC
• Casey Lynn Spanraft, MSW, CADC, LCSW
• Janetta R. Sparks, R.N.
• Laurie Jo Sparr, DNP, APRN, FNP-C
• Kathy Lynn Splaingard, DMD

• Federally Qualified Health Center (FQHC) in Granite City, IL
• Providers in Granite City, 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 Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.