State Street Center

LBN: Southern Illinois Healthcare Foundation, Inc.
State Street Center is an health care organization with primary practice located at 2001 State St , East Saint Louis IL 62205-1803. The organization recently has 5 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Pediatrics, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty. Southern Illinois Healthcare Foundation, Inc. can be contacted via phone (618) 271-9191, or through Mcculley, Larry via phone (618) 332-0783.

Contact Information

Primary practice address
2001 State St East Saint Louis IL 62205-1803
Phone: (618) 271-9191
Fax: (618) 271-9617
Website:
Map and Directions
Authorized official contact:
Name: Mcculley, Larry
Phone: (618) 332-0783

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1811054935
LBN Legal business name Southern Illinois Healthcare Foundation, Inc.
DBA Doing business as State Street Center
Authorized official Mcculley, Larry
Entity Organization
Organization subpart 1 No
Enumeration date Jan 2nd, 2007
Last updated Oct 30th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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