Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Other names
DEPARTMENT OF PSYCHIATRY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J TKACH (CEO)
(217) 545-7578
Entity
Organization
Contact information
Practice address
901 W JEFFERSON ST, SPRINGFIELD, IL 62702-4833
(217) 545-8229
(217) 545-2275
Mailing address
PO BOX 19642, SPRINGFIELD, IL 62794-9642
(217) 545-8229
(217) 545-2275
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
10-0066401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100066401002
—
IL
Enumeration date
02/20/2008
Last updated
06/19/2008
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