Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Primary Care Clinic/Center · Springfield, IL

NPI number 1396097960 Active

Practice location

520 N 4th St
Springfield, IL 62702-5238

Call (217) 757-8100 Map

Fax (217) 747-1351

Mailing address

PO Box 19639
Springfield, IL 62794-9639

Specialties and licenses

TaxonomyCodeLicense
Family Medicine Physician 207Q00000XNone listed
Primary Care Clinic/Center Primary 261QP2300XNone listed

Primary Care Clinic/Center: Definition to come...

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About NPI 1396097960

Board of Trustees of Southern Illinois University's National Provider Identifier is 1396097960, issued on Oct 8, 2012. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Springfield, IL. The record was last updated on Apr 20, 2026.