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Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Other names
SIU SCHOOL OF MEDICINE, Carbondale Care A Van
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRIS WESLEY (C.E.O.)
(217) 545-8137
Entity
Organization
Contact information
Practice address
300 W OAK ST STE 100, CARBONDALE, IL 62901-1496
(618) 453-3777
(618) 453-1102
Mailing address
201 E MADISON ST STE 328, SPRINGFIELD, IL 62702-5131
(217) 545-6523
(217) 545-4410
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/10/2006
Last updated
05/03/2022
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