STATE STREET CENTER - NPI 1811054935 - Clinic/Center in East Saint Louis, IL

Q: What is Southern Illinois Healthcare Foundation, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

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About State Street Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STATE STREET CENTER (NPI 1811054935) is a healthcare organization registered as a federally qualified health center (fqhc) in East Saint Louis, Illinois and active in the NPI registry since January 2007. The organization lists Larry Mcculley, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1811054935

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameSOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.

Location Address2001 STATE STEast Saint Louis, IL 62205-1803

Mailing Address8080 State StEast Saint Louis, IL 62203-1808 · (618) 397-3303 · Fax (618) 397-7802

Phone(618) 271-9191

Fax(618) 271-9617

Organization SubpartNo

Authorized OfficialLarry McculleyChief Operating Officer · (618) 332-0783

Enumeration DateJanuary 2, 2007

Last NPPES UpdateOctober 30, 2008

✔ NPI 1811054935 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedPediatricsTaxonomy 208000000X

Also ListedNurse PractitionerTaxonomy 363L00000X

2001 STATE ST, East Saint Louis, IL 62205

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Other Names 1

Doing Business AsState Street Center

Other Identifiers 3

Medicare ID-Type Unspecified732740IL · Wps Medicare

Medicare ID-Type Unspecified141843IL · Ugs Medicare

Medicaid=========003IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YOLANDA L HOAG ACNPC-AG

Nurse Practitioner (Acute Care)