Healther Providers Data Logo


Provider Type Icon

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC. NPI 1770648917


NPI Information

NPI: 1770648917
Provider Name: SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Doing Business As: FAIRMONT CITY HEALTH CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
2568 N 41ST ST
EAST SAINT LOUIS, IL
ZIP 62201
Phone: (618) 482-4015
Get Directions

SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. is a federally qualified health center (fqhc) clinic center in East Saint Louis, IL. SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. NPI is 1770648917. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Fairmont City Health Center.

The provider's business location address is:

2568 N 41ST ST
EAST SAINT LOUIS, IL
ZIP 62201-204
Phone: (618) 482-4015
Fax: (618) 482-4806

The provider's authorized official is Larry Mcculley .
The authorized official title is President and has the following contact phone number (618) 332-0783.

The enumeration date for this NPI number is 12/27/2006 and was last updated on 7/29/2009.


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
1207Q00000XFamily MedicineNo
2363L00000XNurse PractitionerNo
3261QF0400XClinic/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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1141976MEDICARE ID-TYPE UNSPECIFIEDILLINOISUGS MEDICARE
2732740MEDICARE ID-TYPE UNSPECIFIEDILLINOISWPS MEDICARE
3=========028MEDICAIDILLINOIS

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
Remove or sync iconNPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI
Next NPI »