| Board Of Trustees Of Southern Illinois University | |
|
300 W Oak St Ste 100 Carbondale IL 62901-1496 | |
| (618) 536-6621 | |
| (618) 453-1102 |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 300 W Oak St Ste 100, Carbondale, Illinois |
| Authorized Official Name and Position | Iris Wesley (CEO) |
| Authorized Official Contact | 2177578137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of Southern Illinois University Po Box 19639 Springfield IL 62794-9639 Ph: (217) 545-8000 | Board Of Trustees Of Southern Illinois University 300 W Oak St Ste 100 Carbondale IL 62901-1496 Ph: (618) 536-6621 |
| NPI Number | 1568210425 |
|---|---|
| Provider Enumeration Date | 05/07/2024 |
| Last Update Date | 05/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568210425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W Oak St Ste 100, Carbondale, IL 62901 Phone: 217-545-8000 |