Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Springfield, IL

NPI number 1558099523 Active

Practice location

747 N Rutledge St Ste 2287-B
Springfield, IL 62702-6700

Call (217) 545-8000 Map

Mailing address

PO Box 19639
Springfield, IL 62794-9639

Specialties and licenses

TaxonomyCodeLicense
Federally Qualified Health Center (FQHC) Primary 261QF0400XNone listed

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

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About NPI 1558099523

Board of Trustees of Southern Illinois University's National Provider Identifier is 1558099523, issued on Aug 9, 2022. 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 Aug 9, 2022.