Board of Trustees of Southern Illinois University

NPI #1972049641 in Lincoln, Illinois

Provider Information

NPI Number: 1972049641
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: Jan 18, 2017
Last Updated: Jan 9, 2025

Practice Location

Address: 109 3RD ST
City: Lincoln
State: Illinois
ZIP Code: 62656-2604
Phone: (217) 735-2317

Authorized Official

Name: IRIS WESLEY
Title: CEO
Phone: (217) 545-7876

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X
Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC)	261QF0400X	Primary

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