| Board Of Trustees Of Southern Illinois University | |
|
747 N Rutledge St Ste 2287-b Springfield IL 62702-6700 | |
| (217) 545-8000 | |
| Not Available |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/Center |
| Location | 747 N Rutledge St Ste 2287-b, Springfield, Illinois |
| Authorized Official Name and Position | Iris Wesley (CEO) |
| Authorized Official Contact | 2177578137 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 747 N Rutledge St Ste 2287-b Springfield IL 62702-6700 Ph: (217) 545-8000 |
| NPI Number | 1558099523 |
|---|---|
| Provider Enumeration Date | 08/09/2022 |
| Last Update Date | 08/09/2022 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20221104000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558099523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2833 S Grand Ave E, Springfield, IL 62703 Phone: 221-753-5310 Fax: 217-789-2069 | |
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Michael Bova M D S C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2524 Farragut Dr, Suite C, Springfield, IL 62704 Phone: 217-726-9346 | |
North Dirksen Medical Associates, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3220 Atlanta St, Springfield, IL 62707 Phone: 217-588-7400 | |
Siu Physicians & Surgeons, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 N 1st St, D235, Springfield, IL 62781 Phone: 217-545-7578 Fax: 217-545-1884 | |
B3 Healthcare Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 319 E Madison St Ste 2d, Springfield, IL 62701 Phone: 217-508-5859 |