| Southern Illinois Regional Wellness Center | |
|
1736 Kingshighway East Saint Louis IL 62204-2134 | |
| (618) 874-3120 | |
| (618) 215-4048 |
| Full Name | Southern Illinois Regional Wellness Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1736 Kingshighway, East Saint Louis, Illinois |
| Authorized Official Name and Position | Mark R Freeland (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6188743120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Regional Wellness Center 1736 Kingshighway East Saint Louis IL 62204-2134 Ph: (618) 874-3120 | Southern Illinois Regional Wellness Center 1736 Kingshighway East Saint Louis IL 62204-2134 Ph: (618) 874-3120 |
| NPI Number | 1336258540 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 07/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336258540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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