Provider Demographics
NPI:1487099578
Name:SOUTHERNMOST ILLINOIS COMMUNITY HEALTH IMPROVEMENT CORPORATION
Entity type:Organization
Organization Name:SOUTHERNMOST ILLINOIS COMMUNITY HEALTH IMPROVEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-457-0450
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:IL
Mailing Address - Zip Code:62914-0353
Mailing Address - Country:US
Mailing Address - Phone:618-734-1500
Mailing Address - Fax:618-734-3949
Practice Address - Street 1:13289 KESSLER RD
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:IL
Practice Address - Zip Code:62914-3101
Practice Address - Country:US
Practice Address - Phone:618-734-1500
Practice Address - Fax:618-734-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health