Southern Illinois University

NPI #1306273776 in E Saint Louis, Illinois

Provider Information

NPI Number: 1306273776
Entity Type: Organization
Organization Name: Southern Illinois University
Primary Specialty: Clinic/Center
Enumeration Date: Oct 1, 2013
Last Updated: Oct 1, 2013

Practice Location

Address: 601 JAMES R THOMPSON BLVD
Address 2: BUILDING D, SUITE 2015
City: E Saint Louis
State: Illinois
ZIP Code: 62201-1129
Phone: (618) 482-6959

Authorized Official

Name: KIM WENONA WHITE, PHD, PHCNS-BC
Title: EXECUTIVE DIRECTOR
Phone: (618) 482-6959

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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