- Enrollment id
- O20260612000103
- Enrollment state
- IL
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1801760012
- Multiple npi flag
- N
- Ccn
- C41062
- Associate id
- 1456256874
- Organization name
- SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
- Doing business as name
- SIHF HEALTHCARE PHARMACY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 180 S 3RD ST
- Address line 2
- STE 100
- City
- BELLEVILLE
- State
- IL
- Zip code
- 622201952
- Telephone number
- 6183320694