SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. (NPI# 1811054935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811054935 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC. |
| Other Organization Name | STATE STREET CENTER |
| Practice Address |
2001 State St East Saint Louis IL 62205-1803 |
| Mailing Address |
8080 State St East Saint Louis IL 62203-1808 |
| Practice Telephone | 6182719191 |
| Practice Fax Number | 6182719617 |
| Mailing Telephone | 6183973303 |
| Mailing Fax Number | 6183977802 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-10-30 |
| 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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| State Street Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033573183 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 824 Locust St, Red Bud, IL 62278-1209 | 2016-04-05 |
| 1659506939 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 144 N Washington St, Bunker Hill, IL 62014-1316 | 2009-05-15 |
| 1255514717 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 308 Madison Ave, Madison, IL 62060-1110 | 2007-12-07 |
| 1013198712 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 502 W Virginia Ave, Effingham, IL 62401-2260 | 2007-11-21 |
| 1568643260 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1832 Cleveland Blvd, Granite City, IL 62040-4500 | 2007-11-21 |
| 1740461870 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1425 6th St, Madison, IL 62060-1417 | 2007-11-16 |
| 1023299153 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1218 19th St, Granite City, IL 62040-4501 | 2007-11-16 |
| 1750562880 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 2054 Edison Ave, Granite City, IL 62040-4540 | 2007-11-16 |
| 1386825412 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 3924 Oakmont Dr, Pontoon Beach, IL 62040-4395 | 2007-11-16 |
| 1316126147 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 648 State St, Madison, IL 62060-1420 | 2007-10-29 |
| Street Address |
2001 STATE ST |
| City | EAST SAINT LOUIS |
| State | IL |
| Zip Code | 62205-1803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740247360 | Dolores J Gunn | Family Medicine | 2001 State St, East Saint Louis, IL 62205-1803 | 2006-04-27 |
| 1184845257 | Rina S. Patney | Pediatrics | 2001 State St, East Saint Louis, IL 62205-1803 | 2007-05-02 |
| 1245396886 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 2001 State St, East Saint Louis, IL 62205-1803 | 2006-12-28 |
| 1265527998 | Miguel H. Granger | Family Medicine | 2001 State St, East Saint Louis, IL 62205-1803 | 2006-10-04 |
| 1932202744 | Songyoth Sakdisri | Obstetrics & Gynecology | 2001 State St, East Saint Louis, IL 62205-1803 | 2006-09-07 |
| 1144322264 | Joyce A Mckinney | Registered Nurse | 2001 State St, East Saint Louis, IL 62205-1803 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790156610 | Lessie Bates Davis Neighborhood House | Registered Nurse | 1200 North 13th Street, East Saint Louis, IL 62205 | 2015-10-19 |
| 1114047859 | Herschel Lee Garrett Jr. | Dentist | 4020 Caseyville Ave, East St Louis, IL 62205 | 2007-03-29 |
| 1376871103 | Toni M. Jackson | Massage Therapist | 4806 State St, Home Office, East Saint Louis, IL 62205-1355 | 2009-12-07 |
| 1811347362 | Destinee Hope Grove | Specialist/Technologist | 4901 State St, East Saint Louis, IL 62205-1356 | 2016-06-15 |
| 1053963470 | Stephanie Michelle Tate-patterson | Nurse Practitioner | 4901 State St, East Saint Louis, IL 62205-1356 | 2019-07-16 |
| 1710406962 | Christa R Dyson-spiller | Nurse Practitioner | 4901 State St, East Saint Louis, IL 62205-1356 | 2017-09-19 |
| 1558344986 | Gerard X Blaise | Dentist | 4601 State St, Ste 300, East Saint Louis, IL 62205-1359 | 2005-11-21 |
| 1013269737 | Illinois Express Home Care | In Home Supportive Care | 4601 State St, East Saint Louis, IL 62205-1359 | 2012-10-04 |
| 1427227891 | Comprehensive Mental Health Center of St. Clair County, Inc. | Community/Behavioral Health | 4601 State St, East Saint Louis, IL 62205-1359 | 2008-02-29 |
| 1801065289 | Comprehensive Mental Health Center of St. Clair County, Inc. | Community/Behavioral Health | 4601 State St, East Saint Louis, IL 62205-1359 | 2008-02-29 |
| Find all providers in zip 62205 | ||||
| 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 |
|---|---|---|---|---|
| 1174688501 | Southern Illinois Healthcare Foundation, Inc. | Clinic/Center | 8080 State St, East Saint Louis, IL 62203-1808 | 2006-12-26 |
| 1336258540 | Southern Illinois Regional Wellness Center | Clinic/Center | 1736 Kingshighway, East Saint Louis, IL 62204-2134 | 2006-08-30 |
| 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 | EAST SAINT LOUIS |
| Zip Code | 62205 |
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.