| Sihf Psr Club House Facility | |
|
2057 Edison Ave Suite A Granite City IL 62040-4514 | |
| (618) 397-3303 | |
| (618) 397-7802 |
| Full Name | Sihf Psr Club House Facility |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2057 Edison Ave, Granite City, Illinois |
| Authorized Official Name and Position | Larry Mcculley (COO) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sihf Psr Club House Facility 8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | Sihf Psr Club House Facility 2057 Edison Ave Suite A Granite City IL 62040-4514 Ph: (618) 397-3303 |
| NPI Number | 1821277658 |
|---|---|
| Provider Enumeration Date | 10/29/2007 |
| Last Update Date | 10/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821277658 | NPI | - | NPPES |
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