SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC. NPI 1376588871

NPI Information

NPI: 1376588871
Provider Name: SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Doing Business As: BELLEVILLE PEDIATRIC & ADOLESCENT HEALTH CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
2900 FRANK SCOTT PKWY W
SUITE 950
BELLEVILLE, IL
ZIP 62223
Phone: (618) 233-3205
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SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. is a federally qualified health center (fqhc) clinic center in Belleville, IL. SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. NPI is 1376588871. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Belleville Pediatric & Adolescent Health Center.

The provider's business location address is:

2900 FRANK SCOTT PKWY W
SUITE 950
BELLEVILLE, IL
ZIP 62223-000
Phone: (618) 233-3205
Fax: (618) 233-1407

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

The enumeration date for this NPI number is 6/18/2006 and was last updated on 8/8/2014.

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	Primary
1	208000000X	Pediatrics		No
2	101YP2500X	Counselor	Professional	No
3	1041C0700X	Social Worker	Clinical	No
4	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	=========030	MEDICAID	ILLINOIS
2	732740	OTHER	ILLINOIS	WPS MEDICARE

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

NPI Synchronization or Removal

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