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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