| Board Of Trustees Of Southern Illinois University | |
|
1600 E Clear Lake Ave Ste 120 Springfield IL 62703-1172 | |
| (217) 545-8000 | |
| Not Available |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 E Clear Lake Ave Ste 120, Springfield, Illinois |
| Authorized Official Name and Position | Shelby Renee Burdick (TEAM LEAD, MEDICAL STAFF) |
| Authorized Official Contact | 2175456523 |
| 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 201 E Madison St Ste 328 Springfield IL 62702-5131 Ph: (217) 545-6523 | Board Of Trustees Of Southern Illinois University 1600 E Clear Lake Ave Ste 120 Springfield IL 62703-1172 Ph: (217) 545-8000 |
| NPI Number | 1770259764 |
|---|---|
| Provider Enumeration Date | 08/19/2021 |
| Last Update Date | 08/19/2021 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20211216000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770259764 | 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 | |
Professional Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 701 N 1st St, Springfield, IL 62781 Phone: 217-788-3000 | |
Hshs Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3215 Executive Park Dr, Springfield, IL 62703 Phone: 217-523-5406 | |
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 |