Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other names
SIU FQHC - General Internal Medicine Clinic
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
747 N RUTLEDGE ST STE 2287-B, SPRINGFIELD, IL 62702-6700
(217) 545-8000
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/09/2022
Last updated
08/09/2022
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