Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS WESLEY (CEO)
(217) 545-8000
Entity
Organization
Contact information
Practice address
205 S 24TH ST STE 100, QUINCY, IL 62301-4446
(217) 224-9484
(217) 224-7950
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7876
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/02/2019
Last updated
10/02/2019
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