BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1104230168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104230168 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Other Organization Name | SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE |
| Practice Address |
601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 |
| Practice Telephone | 6184826959 |
| Practice Fax Number | 6184828311 |
| Mailing Telephone | 6184826959 |
| Mailing Fax Number | 6184828311 |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2019-02-26 |
| Authorized Official Name | RICKI LOAR (DIRECTOR OF THE WE CARE CLINIC) |
| Authorized Official Telephone | 6184826959 |
| Authorized Official Credential | APRN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Southern Illinois University Edwardsville | Doing Business As Name - Organization |
| Southern Illinois University Edwardsville | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396386181 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak St Ste 100, Carbondale, IL 62901-1496 | 2019-10-02 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1558848473 | Board of Trustees of Southern Illinois University | Clinic/Center | 2833 S Grand Ave E Ste 100, Springfield, IL 62703-2175 | 2018-07-24 |
| 1003324260 | Board of Trustees of Southern Illinois University | Clinic/Center | 4409 Maine St Ste 100, Quincy, IL 62305-5849 | 2018-01-22 |
| 1083121537 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 100, Quincy, IL 62301-2700 | 2018-01-05 |
| 1922515451 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 211, Quincy, IL 62301-2700 | 2018-01-05 |
| 1679188437 | Board of Trustees of Southern Illinois University | Clinic/Center | 751 N Rutledge St Ste 1100, Springfield, IL 62702-4968 | 2020-09-09 |
| 1619501871 | Board of Trustees of Southern Illinois University | Clinic/Center | 606 W Adams St, Pittsfield, IL 62363-1308 | 2020-02-26 |
| 1851934871 | Board of Trustees of Southern Illinois University | Clinic/Center | 303 E Bidwell St, Taylorville, IL 62568-1363 | 2019-10-22 |
| Street Address |
601 JAMES R THOMPSON BLVD BUILDING D, SUITE 2015 |
| City | EAST SAINT LOUIS |
| State | IL |
| Zip Code | 62201-1129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831291830 | Linda Washington Omondi | Nurse Practitioner | 601 James R Thompson Blvd, Building D, Suite 2015, East Saint Louis, IL 62201-1129 | 2006-09-01 |
| 1649622622 | Chontay L Mckay | Nurse Practitioner | 601 James R Thompson Blvd, Building D, Suite 2015, East Saint Louis, IL 62201-1129 | 2016-07-01 |
| 1992153639 | Megan Degroot | Counselor | 601 James R Thompson Blvd, Building D, Suite 2015, East Saint Louis, IL 62201-1129 | 2016-06-02 |
| 1427470368 | Kim Wenona White | Clinical Nurse Specialist | 601 James R Thompson Blvd, Building D, Suite 2015, East Saint Louis, IL 62201-1129 | 2014-01-13 |
| 1467753459 | Janet C Whitworth | Nurse Practitioner | 601 James R Thompson Blvd, Bldg D 2015, East Saint Louis, IL 62201-1129 | 2010-11-08 |
| 1518140326 | Southern Illinois University Edwardsville | Clinic/Center | 601 James R Thompson Blvd, Building D 2015, East Saint Louis, IL 62201-1129 | 2007-12-14 |
| 1215078928 | Theresa M Benassi-powles | Nurse Practitioner | 601 James R Thompson Blvd, Building D 2015, East Saint Louis, IL 62201-1129 | 2007-02-08 |
| 1205976636 | Virginia L Behrhorst | Nurse Practitioner | 601 James R Thompson Blvd, Building D 2015, East Saint Louis, IL 62201-1129 | 2007-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417593724 | Brighter Hope Inc | Clinic/Center | 1400 E. Broadway, East St Louis, IL 62201 | 2019-11-21 |
| 1659759918 | Olde Tyme Optical | Technician/Technologist | 100 N. 8th St E., Suite 264, E. St. Louis, IL 62201 | 2015-05-07 |
| 1689890006 | Carrie Ann Settlemoir | Chiropractor | 699 Rte. 203, Suite 101, E.st.louis, IL 62201 | 2007-04-17 |
| 1659417582 | Brett Irvin | Dentist | 1511 East Broadway, St Louis, IL 62201 | 2007-01-29 |
| 1386700771 | Laura A. Collier | Registered Nurse | 540 North 6th Street, East Saint Louis, IL 62201 | 2006-12-29 |
| 1366508053 | Yetzenia Aramis Arauz | Registered Nurse | 2568 North 41st Street, Fairmont City, IL 62201 | 2006-12-28 |
| 1255426466 | Hee Man Song | Specialist | 100 North 8th Street, Suite 232, East St Louis, IL 62201 | 2006-10-04 |
| 1821109737 | Richard Joseph Fleming | Physical Therapist | 144 Lincoln Place Ct, Suite 1, Belleville, IL 62201 | 2006-08-31 |
| 1942510508 | Southern Illinois Health Care Foundation, Inc. | Family Medicine | 505 S 8th St, East Saint Louis, IL 62201 | 2010-10-18 |
| 1104157437 | United We Trust Home Care | Case Management | 327 Missouri Ave, Suite 300, East Saint Louis, IL 62201 | 2010-01-27 |
| Find all providers in zip 62201 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457665382 | Roadside Medical, LLC | Clinic/Center | 699 State Route 203, Suite 1, East Saint Louis, IL 62201-1608 | 2010-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568069805 | Elite Spine & Wellness Center, Inc | Clinic/Center | 5898 Pathfinder Rd, Rockford, IL 61109-4008 | 2020-10-08 |
| 1407453236 | Dirsi, Inc | Clinic/Center | 2112 N Dayton St, Chicago, IL 60614-4302 | 2020-10-05 |
| 1588261770 | Mount Sinai Community Foundation Dba Sinai Medical Group | Clinic/Center | 2701 W 68th St Fl 3, Chicago, IL 60629-1813 | 2020-10-01 |
| 1013514298 | Mount Sinai Community Foundation Dba Sinai Medical Group | Clinic/Center | 1500 S Fairfield Ave Fl 4, Chicago, IL 60608-1782 | 2020-10-01 |
| 1841804879 | Chicago Poly Clinic LLC | Clinic/Center | 2446 W Devon Ave, Chicago, IL 60659-1913 | 2020-09-08 |
| 1386258226 | Ortho Spine Surgical LLC | Clinic/Center | 1925 E 95th St Ste 220, Chicago, IL 60617-4710 | 2020-09-08 |
| 1821607425 | Desired Medical Services Incorporated | Clinic/Center | 371 Mackinaw Ave, Calumet City, IL 60409-2524 | 2020-07-29 |
| 1639787823 | Md Infusions, Pllc | Clinic/Center | 666 Dundee Rd Ste 1800, Northbrook, IL 60062-2727 | 2020-07-14 |
| 1407474083 | Staten Family Practice Pllc | Clinic/Center | 500 W Virginia Ave, Gillespie, IL 62033-1025 | 2020-07-09 |
| 1629696679 | Serenity Internal Medicine & Wellness Center | Clinic/Center | 3330 W 177th St # 2d-1, Hazel Crest, IL 60429-2184 | 2020-07-07 |
| Find all providers with the same taxonomy | ||||
| City | EAST SAINT LOUIS |
| Zip Code | 62201 |
Please comment or provide details below to improve the information on BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.