SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC (NPI# 1811236458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811236458 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC |
| Other Organization Name | MILLSTADT MEDICAL CLINIC |
| Practice Address |
60 Regency Pl Millstadt IL 62260-2210 |
| Mailing Address |
2041 Goose Lake Rd Sauget IL 62206-2822 |
| Practice Telephone | 6184769177 |
| Practice Fax Number | 6184761890 |
| Mailing Telephone | 6183320953 |
| Mailing Fax Number | 6183322487 |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2013-02-01 |
| Authorized Official Name | LARRY MCCULLEY (CEO) |
| Authorized Official Telephone | 6183320694 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | IL | Allopathic & Osteopathic Physicians | |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Millstadt Medical Clinic | 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 |
| 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 |
| 1801822010 | Southern Illinois Healthcare Foundation, Inc | Internal Medicine | 2100 Madison Ave, Granite City, IL 62040-4701 | 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 |
60 REGENCY PL |
| City | MILLSTADT |
| State | IL |
| Zip Code | 62260-2210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649241951 | Mary Hollenkamp | Nurse Practitioner | 60 Regency Pl, Millstadt, IL 62260-2210 | 2006-01-27 |
| 1285113217 | Malissa Weber | Nurse Practitioner | 60 Regency Pl, Millstadt, IL 62260-2210 | 2018-08-10 |
| 1740720143 | Ashley N Hundelt | Nurse Practitioner | 60 Regency Pl, Millstadt, IL 62260-2210 | 2017-03-03 |
| 1932421047 | Family Health Associates Sc | Family Medicine | 60 Regency Pl, Millstadt, IL 62260-2210 | 2010-02-17 |
| 1992882666 | Laboratory Corporation of America | Clinical Medical Laboratory | 60 Regency Pl, Millstadt, IL 62260-2210 | 2006-11-01 |
| 1326056540 | Alana C Thompson-byrd | Family Medicine | 60 Regency Pl, Millstadt, IL 62260-2210 | 2006-08-03 |
| 1669426383 | Murtaza Hayat | Internal Medicine | 60 Regency Pl, Millstadt, IL 62260-2210 | 2006-05-19 |
| 1316944986 | Carla Elaine Samson | Family Medicine | 60 Regency Pl, Millstadt, IL 62260-2210 | 2005-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952443616 | Lauren Elizabeth Milton | Occupational Therapist | 3307 Mill Park Ct, Millstadt, IL 62260 | 2007-02-12 |
| 1053487074 | John F Touchette | Dentist | 9 E Van Buren, Millstadt, IL 62260 | 2006-11-28 |
| 1326158114 | Philip Matthew Acker | Dentist | 502 W Washington, Millstadt, IL 62260 | 2006-08-30 |
| 1447203245 | Brian C Blair | Pharmacist | 120 W Washington, Millstadt, IL 62260 | 2006-05-19 |
| 1265563662 | Penny Bobcik | Pharmacist | 120 W Washington, Millstadt, IL 62260 | 2007-03-08 |
| 1487819306 | Ulrica Elisabeth Bateman | Speech-Language Pathologist | 105 W Parkview Dr, Millstadt, IL 62260-1127 | 2008-07-21 |
| 1477692911 | Millstadt Ccsd 160 | Local Education Agency (LEA) | 211 W Mill St, Millstadt, IL 62260-1147 | 2007-02-05 |
| 1588277412 | Amy Perez | Speech-Language Pathologist | 211 W Mill St, Millstadt, IL 62260-1147 | 2020-08-29 |
| 1164529723 | Jared P Isom | Dentist | 200 W Mill St, Millstadt, IL 62260-1148 | 2006-09-17 |
| 1326651613 | Bwe & Tme Inc | Pharmacy | 120 W Washington St, Millstadt, IL 62260-1156 | 2020-08-26 |
| Find all providers in zip 62260 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 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 | ||||
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| 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.