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General NPI Number Information
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NPI Number | 1912853748
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS HEALTH CARE FOUNDATION, INC.
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 4017 STATE ROUTE 159
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City | SMITHTON
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State | IL
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Zip | 62285-2510
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Country | US
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Telephone | 618-394-9630
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Fax | 618-394-9631
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Provider Business Mailing Address
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Address Line | 2041 GOOSE LAKE RD
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City | SAUGET
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State | IL
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Zip | 62206-2822
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Country | US
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Telephone | 618-332-0953
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Fax | 618-332-2487
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Authorized Official
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Title or Position | SR. VICE PRESIDENT
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Name | DANIEL E WINKLE
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Credential |
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Telephone | 618-332-0694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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