Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Quincy, IL

NPI number 1083121537 Active

Practice location

330 Vermont St Ste 100
Quincy, IL 62301-2700

Call (217) 222-8440 Map

Fax (217) 222-8508

Mailing address

PO Box 19639
Springfield, IL 62794-9639

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed
Primary Care Clinic/Center	261QP2300X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

4 other providers at this address

Other federally qualified health center (fqhc) providers in Quincy

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NPI record

NPI: 1083121537
Entity type: Organization (Type 2)
Issued: Jan 5, 2018
Last updated: Jan 9, 2025
Status: Active
Subpart: Yes of Board of Trustees of Southern Illinois University

Other names

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Siu Center for Family Medicine - Adams County Dental Clinic · other name

Authorized official

Iris Wesley
CEO
(217) 545-8000

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1083121537

Board of Trustees of Southern Illinois University's National Provider Identifier is 1083121537, issued on Jan 5, 2018. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Quincy, IL. The record was last updated on Jan 9, 2025.