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SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC NPI 1275561797


NPI Information

NPI: 1275561797
Provider Name: SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC

Doing Business As: WEST BELLEVILLE HEALTH CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
7210 W MAIN ST
BELLEVILLE, IL
ZIP 62223
Phone: (618) 394-0712
Get Directions

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC is a federally qualified health center (fqhc) clinic center in Belleville, IL. SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC NPI is 1275561797. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As West Belleville Health Center.

The provider's business location address is:

7210 W MAIN ST
BELLEVILLE, IL
ZIP 62223-038
Phone: (618) 394-0712
Fax: (618) 394-1346

The provider's authorized official is Larry Mcculley .
The authorized official title is Chief Executive Officer and has the following contact phone number (618) 332-0694.

The enumeration date for this NPI number is 6/30/2006 and was last updated on 11/3/2011.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineNo
2207V00000XObstetrics & GynecologyNo
3208000000XPediatricsNo
4122300000XDentistNo
5261QF0400XClinic/CenterFederally 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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1732740OTHERILLINOISWPS MEDICARE GROUP NUMBER
2141929MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
3=========025MEDICAIDILLINOIS

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: 11/14/2023

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