Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Springfield, IL

NPI number 1497002182 Active

Practice location

520 N 4th St
Springfield, IL 62702-5238

Call (217) 545-8000 Map

Fax (217) 757-8161

Mailing address

PO Box 19639
Springfield, IL 62794-9639

Specialties and licenses

TaxonomyCodeLicense
Federally Qualified Health Center (FQHC) Primary 261QF0400XNone listed
Primary Care Clinic/Center 261QP2300XNone listed

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

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About NPI 1497002182

Board of Trustees of Southern Illinois University's National Provider Identifier is 1497002182, issued on Aug 13, 2012. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Springfield, IL. The record was last updated on Jan 9, 2025.