SOUTHERN IL REGIONAL WELLNESS CENTER – NPI #1295194009
Clinic/Center

SOUTHERN IL REGIONAL WELLNESS CENTER is an AHC clinic located in WASHINGTON PARK, IL. NPPES has assigned the NPI number 1295194009 to SOUTHERN IL REGIONAL WELLNESS CENTER on February 22, 2016. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 10 years ago on May 24, 2016. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHERN IL REGIONAL WELLNESS CENTER below.

NPI Profile for
SOUTHERN IL REGIONAL WELLNESS CENTER

NPI Number
1295194009
Enumeration Date

(more than 10 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHERN IL REGIONAL WELLNESS CENTER
Primary location
1736 KINGSHIGHWAY
WASHINGTON PARK, IL 62204-2135
Phone: (618) 482-7922 Fax: (618) 215-4048
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MARK FREELAND
CEO
Phone: (618) 482-7922
Updated
Identifiers

Identifiers for SOUTHERN IL REGIONAL WELLNESS CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERNPIIL1336258540
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.