Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Jacksonville, IL

NPI number 1598412447 Active

Practice location

425 E State St., Ste 100
Jacksonville, IL 62650-2125

Call (217) 408-1195 Map

Fax (217) 408-1231

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...

Another provider at this address

Jodie D. Vanmeter, FNP-BCFamily Nurse Practitioner Jacksonville, IL NPI 1972769719

Other federally qualified health center (fqhc) providers in Jacksonville

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NPI record

NPI: 1598412447
Entity type: Organization (Type 2)
Issued: Mar 9, 2022
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-Jacksonville · doing business as
Siu Center for Family Medicine-Jacksonville · doing business as

Authorized official

Iris Wesley
CEO
(217) 545-8000

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1598412447

Board of Trustees of Southern Illinois University's National Provider Identifier is 1598412447, issued on Mar 9, 2022. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Jacksonville, IL. The record was last updated on Jan 9, 2025.