SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC. NPI 1811054935

NPI Information

NPI: 1811054935
Provider Name: SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Doing Business As: STATE STREET CENTER

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

Specialization: Federally Qualified Health Center (FQHC)

Address:
2001 STATE ST
EAST SAINT LOUIS, IL
ZIP 62205
Phone: (618) 271-9191
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 1811054935. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As State Street Center.

The provider's business location address is:

2001 STATE ST
EAST SAINT LOUIS, IL
ZIP 62205-803
Phone: (618) 271-9191
Fax: (618) 271-9617

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

The enumeration date for this NPI number is 1/2/2007 and was last updated on 10/30/2008.

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	207Q00000X	Family Medicine		No
2	207V00000X	Obstetrics & Gynecology		No
3	208000000X	Pediatrics		No
4	363L00000X	Nurse Practitioner		No
5	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	732740	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	WPS MEDICARE
2	141843	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	UGS MEDICARE
3	=========003	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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