Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other names
SIU Center for Healthy Aging and Wellness
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
IRIS WESLEY (CEO)
(217) 757-8137
Entity
Organization
Contact information
Practice address
319 E MADISON ST STE 1F, SPRINGFIELD, IL 62701-3118
(217) 545-8000
(217) 757-8161
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-6523
(217) 545-4410
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
10/21/2022
Last updated
01/09/2025
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