SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER NPI 1265588776

NPI Information

NPI: 1265588776
Provider Name: SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER

Doing Business As: HEALTH AND OPPORTUNITY CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
1835 KINGSHIGHWAY
WASHINGTON PARK, IL
ZIP 62204
Phone: (618) 482-7922
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SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER is a federally qualified health center (fqhc) clinic center in Washington Park, IL. SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER NPI is 1265588776. The provider is registered as an organization entity type.
The provider Is Doing Business As Health And Opportunity Center.

The provider's business location address is:

1835 KINGSHIGHWAY
WASHINGTON PARK, IL
ZIP 62204-135
Phone: (618) 482-7922
Fax: (618) 482-7881

The provider's authorized official is Mark R Freeland .
The authorized official title is Executive Director and has the following contact phone number (618) 874-3120.

The enumeration date for this NPI number is 1/26/2007 and was last updated on 12/6/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	141956	MEDICARE PIN	ILLINOIS
2	=========002	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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