Organization · Type 2 NPI
Board of Trustees of Southern Illinois University
Federally Qualified Health Center (FQHC) · Jacksonville, IL
NPI number
1649628009
Active
Practice location
345 W State St
Jacksonville, IL 62650-1879
Fax (217) 243-4773
Mailing address
520 N 4th St, PO Box 19671
Springfield, IL 62702-5238
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Federally Qualified Health Center (FQHC) Primary | 261QF0400X | None listed |
Federally Qualified Health Center (FQHC): Definition to come...
Another provider at this address
Other federally qualified health center (fqhc) providers in Jacksonville
About NPI 1649628009
Board of Trustees of Southern Illinois University's National Provider Identifier is 1649628009, issued on May 26, 2016. 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 May 26, 2016.