Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other names
SIU Center for Family Medicine-Jacksonville
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
IRIS WESLEY (CEO)
(217) 545-8000
Entity
Organization
Contact information
Practice address
425 E STATE ST., STE 100, JACKSONVILLE, IL 62650-2125
(217) 408-1195
(217) 408-1231
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
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
03/09/2022
Last updated
01/09/2025
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