Board of Trustees of Southern Illinois University
NPI #1205553195 in Springfield, Illinois
Provider Information
- NPI Number
- 1205553195
- Entity Type
- Organization
- Organization Name
- Board of Trustees of Southern Illinois University
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
- Primary Specialty
- Clinic/Center - Federally Qualified Health Center (FQHC)
- Enumeration Date
- Oct 21, 2022
- Last Updated
- Jan 9, 2025
Practice Location
- Address
- 319 E MADISON ST STE 1F
- City
- Springfield
- State
- Illinois
- ZIP Code
- 62701-3118
- Phone
- (217) 545-8000
Authorized Official
- Name
- IRIS WESLEY
- Title
- CEO
- Phone
- (217) 757-8137
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Primary Care — Primary Care |
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
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