Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Carbondale, IL

NPI number 1437708674 Active

Practice location

300 W Oak St
Carbondale, IL 62901-1400

Call (618) 536-6621 Map

Fax (618) 453-1102

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...

39 other providers at this address

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NPI record

NPI: 1437708674
Entity type: Organization (Type 2)
Issued: Sep 10, 2019
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 - Carbondale · doing business as

Authorized official

Iris Wesley
CEO
(217) 545-8000

Verify this record

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About NPI 1437708674

Board of Trustees of Southern Illinois University's National Provider Identifier is 1437708674, issued on Sep 10, 2019. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Carbondale, IL. The record was last updated on Jan 9, 2025.