# BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SIU SCHOOL OF MEDICINE, Carbondale Care A Van
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215978127
- **Authorized official:** MR. IRIS WESLEY (C.E.O.)
- **Authorized official phone:** (217) 545-8137

## Contact information

- **Practice address:** 300 W OAK ST STE 100, CARBONDALE, IL 62901-1496
- **Practice address phone:** (618) 453-3777
- **Practice address fax:** (618) 453-1102
- **Mailing address:** 201 E MADISON ST STE 328, SPRINGFIELD, IL 62702-5131
- **Mailing address phone:** (217) 545-6523
- **Mailing address fax:** (217) 545-4410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 05/03/2022