Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
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 - Integrated Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
IRIS WESLEY (CHIEF EXECUTIVE OFFICER)
(217) 545-7876
Entity
Organization
Contact information
Practice address
710 N 8TH ST, SPRINGFIELD, IL 62702-6324
(217) 525-1064
(217) 525-1503
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
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
07/24/2017
Last updated
01/09/2025
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