Southern Illinois Healthcare Foundation, Inc.
NPI #1619150174 in Granite City, Illinois
Provider Information
- NPI Number
- 1619150174
- Entity Type
- Organization
- Organization Name
- Southern Illinois Healthcare Foundation, Inc.
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- Dec 7, 2007
- Last Updated
- Apr 12, 2011
Practice Location
- Address
- 1820 DELMAR AVE
- City
- Granite City
- State
- Illinois
- ZIP Code
- 62040-4507
- Phone
- (618) 877-4489
Authorized Official
- Name
- MR. LARRY MCCULLEY
- Title
- CHIEF EXECUTIVE OFFICER
- Phone
- (618) 332-0649
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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