Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Other names
SIU CENTER FOR FAMILY MEDICINE - NOLL
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS WESLEY (CEO/FQHC DIRECTOR)
(217) 545-8000
Entity
Organization
Contact information
Practice address
5220 S 6TH STREET RD, SUITE 1500, SPRINGFIELD, IL 62703-5735
(217) 545-8000
(217) 747-1351
Mailing address
PO BOX 19670, SPRINGFIELD, IL 62794-9670
(217) 545-8000
(217) 747-1351
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Enumeration date
08/11/2015
Last updated
08/13/2015
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