Organization · Type 2 NPI

Board of Trustees of Southern Illinois University

Federally Qualified Health Center (FQHC) · Lincoln, IL

NPI number 1972049641 Active

Practice location

109 3rd St
Lincoln, IL 62656-2604

Call (217) 735-2317 Map

Fax (217) 732-6943

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...

9 other providers at this address

NPI record

NPI: 1972049641
Entity type: Organization (Type 2)
Issued: Jan 18, 2017
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 - Lincoln · doing business as

Authorized official

Iris Wesley
CEO
(217) 545-7876

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 1972049641

Board of Trustees of Southern Illinois University's National Provider Identifier is 1972049641, issued on Jan 18, 2017. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Lincoln, IL. The record was last updated on Jan 9, 2025.