Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
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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