SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER – NPI #1336258540
Clinic/Center

SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER is an AHC clinic located in EAST SAINT LOUIS, IL. NPPES has assigned the NPI number 1336258540 to SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER on August 30, 2006. 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 Jul 06, 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 ILLINOIS REGIONAL WELLNESS CENTER below.

NPI Profile for
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER

NPI Number
1336258540
Enumeration Date

(about 20 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 ILLINOIS REGIONAL WELLNESS CENTER
Primary location
1736 KINGSHIGHWAY
EAST SAINT LOUIS, IL 62204-2134
Phone: (618) 874-3120 Fax: (618) 215-4048
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MARK FREELAND
EXECUTIVE DIRECTOR
Phone: (618) 874-3120
Updated
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.