Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Springfield, IL

NPI number 1679188437 Active

Practice location

751 N Rutledge St Ste 1100
Springfield, IL 62702-4968

Call (217) 545-8000 Map

Fax (217) 545-4735

Mailing address

PO Box 19639
Springfield, IL 62794-9639

Other practice locations

747 N Rutledge St Ste 2287-B, Springfield, IL 62702-6700 · (217) 545-8000

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...

25 other providers at this address

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NPI record

NPI: 1679188437
Entity type: Organization (Type 2)
Issued: Sep 9, 2020
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 - General Internal Medicine Clinic · doing business as

Authorized official

Iris Wesley
CEO
(217) 545-8000

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About NPI 1679188437

Board of Trustees of Southern Illinois University's National Provider Identifier is 1679188437, issued on Sep 9, 2020. 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.