| Siu Center For Family Medicine-jacksonville | |
|
345 W State St Jacksonville IL 62650-1879 | |
| (217) 245-5111 | |
| (217) 243-4773 |
| Full Name | Siu Center For Family Medicine-jacksonville |
|---|---|
| Speciality | Clinic/Center |
| Location | 345 W State St, Jacksonville, Illinois |
| Authorized Official Name and Position | Iris Wesley (CEO) |
| Authorized Official Contact | 2175458000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Siu Center For Family Medicine-jacksonville 520 N 4th St Po Box 19671 Springfield IL 62702-5238 Ph: (217) 545-8000 | Siu Center For Family Medicine-jacksonville 345 W State St Jacksonville IL 62650-1879 Ph: (217) 245-5111 |
| NPI Number | 1649628009 |
|---|---|
| Provider Enumeration Date | 05/26/2016 |
| Last Update Date | 05/26/2016 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20160725001980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649628009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
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