Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other names
SIU Center for Family Medicine - Sangamon County Health Mobile Unit
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
IRIS WESLEY (CEO)
(217) 545-8000
Entity
Organization
Contact information
Practice address
2833 S GRAND AVE E, SPRINGFIELD, IL 62703-2175
(221) 753-5310
(217) 789-2069
Mailing address
PO BOX 19670, SPRINGFIELD, IL 62794-9670
(217) 535-3102
(217) 789-2069
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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