Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Decatur, IL

NPI number 1407376338 Active

Practice location

102 W Kenwood Ave
Decatur, IL 62526-4368

Call (217) 872-3800 Map

Fax (217) 872-0849

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...

24 other providers at this address

Other federally qualified health center (fqhc) providers in Decatur

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NPI record

NPI: 1407376338
Entity type: Organization (Type 2)
Issued: Jun 21, 2017
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 - Decatur · doing business as

Authorized official

Iris Wesley
Chief Executive Officer
(217) 545-7876

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About NPI 1407376338

Board of Trustees of Southern Illinois University's National Provider Identifier is 1407376338, issued on Jun 21, 2017. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Decatur, IL. The record was last updated on Jan 9, 2025.