SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC (NPI# 1801822010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801822010 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC |
| Other Organization Name | KOCH HEALTH CENTER |
| Practice Address |
2100 Madison Ave Granite City IL 62040-4701 |
| Mailing Address |
8080 State St East Saint Louis IL 62203-1808 |
| Practice Telephone | 6184523301 |
| Practice Fax Number | 6184523312 |
| Mailing Telephone | 6183973303 |
| Mailing Fax Number | 6183977802 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. LARRY MCCULLEY (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 6183320783 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | WPS MEDICARE GROUP NUMBER | 732740 | 01 |
| Other Name | Type Code |
|---|---|
| Koch Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497033948 | Southern Illinois Healthcare Foundation, Inc | Family Medicine | 660 S Truman Blvd, Festus, MO 63028-2235 | 2011-08-02 |
| 1881145357 | Southern Illinois Healthcare Foundation, Inc | Social Worker | 750 Broadway Ave E, Mattoon, IL 61938-4610 | 2016-10-20 |
| 1811236458 | Southern Illinois Healthcare Foundation, Inc | Family Medicine | 60 Regency Pl, Millstadt, IL 62260-2210 | 2013-02-01 |
| 1326392747 | Southern Illinois Healthcare Foundation, Inc | Counselor | 2166 Madison Avenue, Granite City, IL 62040 | 2012-11-07 |
| 1538449509 | Southern Illinois Healthcare Foundation, Inc | Family Medicine | 5900 Bond Ave, Centreville, IL 62207-2326 | 2011-08-23 |
| 1275561797 | Southern Illinois Healthcare Foundation, Inc | Family Medicine | 7210 W Main St, Belleville, IL 62223-3038 | 2006-06-30 |
| 1831125038 | Southern Illinois Healthcare Foundation, Inc | Family Medicine | 100 N 8th St, East St Louis, IL 62201-2989 | 2006-06-23 |
| 1356377568 | Southern Illinois Healthcare Foundation, Inc | Nurse Practitioner | 2 Memorial Dr, Suite 122, Alton, IL 62002-6723 | 2006-06-23 |
| Street Address |
2100 MADISON AVE |
| City | GRANITE CITY |
| State | IL |
| Zip Code | 62040-4701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265439640 | Timothy Hipskind | Internal Medicine | 2100 Madison Ave, Granite City, IL 62040-4701 | 2005-06-30 |
| 1720606973 | Lisa Lawrence | Social Worker | 2100 Madison Ave, Granite City, IL 62040-4713 | 2020-07-13 |
| 1588283360 | Bridget Burwell | Nurse Practitioner | 2100 Madison Ave, Granite City, IL 62040-4713 | 2020-04-13 |
| 1457982050 | Steven T Hillmer | Dietitian, Registered | 2100 Madison Ave, Granite City, IL 62040-4713 | 2020-02-01 |
| 1366090573 | Donald Lee Clark IIi | Nurse Practitioner | 2100 Madison Ave, Granite City, IL 62040-4713 | 2019-08-30 |
| 1407412752 | Great River Radiology, Inc | Radiology | 2100 Madison Ave, Granite City, IL 62040 | 2019-05-13 |
| 1831601376 | Cep America - Illinois Snf, LLP | Internal Medicine | 2100 Madison Ave, Granite City, IL 62040-4713 | 2017-10-24 |
| 1467977561 | Anna Gilbreth | Nurse Practitioner | 2100 Madison Ave, Granite City, IL 62040-4713 | 2017-08-09 |
| 1952831893 | Kendall Brennan Knobeloch | Registered Nurse | 2100 Madison Ave, Granite City, IL 62040-4713 | 2017-06-13 |
| 1295262459 | Emily Marie Cottrell | Nurse Practitioner | 2100 Madison Ave, Granite City, IL 62040-4713 | 2017-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043736705 | Christine S Bieniecki Canada | Speech-Language Pathologist | 2300 West 25th St, Granite City, IL 62040 | 2017-08-15 |
| 1881085819 | James Watson | Counselor | 50 Northgate Industrial Drive, Granite City, IL 62040 | 2015-02-12 |
| 1518208719 | Chestnut Health Systems | Clinic/Center | 110 Northagte Industrial Drive, Granite City, IL 62040 | 2013-03-13 |
| 1952651697 | Victor Manuel Pinones | Dentist | 2130 Johnson Rd., Granite City, IL 62040 | 2012-09-10 |
| 1427360502 | Erin K Boerm | Occupational Therapist | 3540 Village Lane, Granite City, IL 62040 | 2010-07-06 |
| 1659503027 | Toni Lyn Siler | Counselor | 101 Whitsell Way, Apt 102, Pontoon Beach, IL 62040 | 2009-08-18 |
| 1871741462 | Fountain View Manor LLC | Alzheimer Center (Dementia Center) | 3432 Village Lane, Granite City, IL 62040 | 2008-09-08 |
| 1083880595 | Christina Marie Darin | Chiropractor | 2013 Johnson Road, Suite C & D, Granite City, IL 62040 | 2008-05-05 |
| 1629244322 | Julia Elaine Uhring Green | Counselor | 2429 Washinton Ave, Granite City, IL 62040 | 2008-05-02 |
| 1578786117 | John K Parker | Preventive Medicine | Veeder Health Center, 20th and Iowa, Granite City, IL 62040 | 2007-04-11 |
| Find all providers in zip 62040 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326417080 | Chestnut Health Systems, Inc | Clinic/Center | 50 Northgate Industrial Dr, Granite City, IL 62040-6805 | 2015-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417567108 | Pillars Community Health | Clinic/Center | 15w458 91st St, Burr Ridge, IL 60527-6379 | 2020-08-06 |
| 1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
| 1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
| 1639791569 | Community Health Partnership of Illinois | Clinic/Center | 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 | 2020-05-14 |
| 1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
| 1235769704 | Greater Elgin Family Care Center | Clinic/Center | 451 N Mclean Blvd, Elgin, IL 60123-3239 | 2020-01-23 |
| 1710517537 | Greater Elgin Family Care Center Integrated Health Home | Clinic/Center | 1100 Shirley Ave, Streamwood, IL 60107-3068 | 2020-01-21 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
| City | GRANITE CITY |
| Zip Code | 62040 |
Please comment or provide details below to improve the information on SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.