BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1558848473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558848473 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Other Organization Name | SIU CENTER FOR FAMILY MEDICINE - SANGAMON COUNTY HEALTH |
| Practice Address |
2833 S Grand Ave E Ste 100 Springfield IL 62703-2175 |
| Mailing Address |
Po Box 19639 Springfield IL 62794-9639 |
| Practice Telephone | 2175353100 |
| Practice Fax Number | 2175353104 |
| Mailing Telephone | 2175457876 |
| Mailing Fax Number | 2175451884 |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-07-24 |
| Authorized Official Name | IRIS WESLEY (CEO) |
| Authorized Official Telephone | 2175457876 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SIU Center for Family Medicine - Sangamon County Health | Doing Business As Name - 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 |
| 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 |
| 1023585312 | Board of Trustees of Southern Illinois University | Clinic/Center | 2833 S Grand Ave E, Springfield, IL 62703-2175 | 2018-10-25 |
| Street Address |
2833 S GRAND AVE E STE 100 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62703-2175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790260917 | Jessica Lynne Zeeck | Behavior Technician | 5220 6th Street Frontage Road, E Suite 1700, Springfield, IL 62703 | 2018-10-03 |
| 1215415799 | Bree Schmulbach | Nurse Practitioner | Bsb Room 20, Springfield, IL 62703 | 2018-08-06 |
| 1144712100 | Fresenius Medical Care Springfield East, LLC | Clinic/Center | 140 S. Martin Luther King Jr. Drive, Springfield, IL 62703 | 2018-06-05 |
| 1558889170 | Ji Woung Choi | Dentist | 687 E Linton Ave., Springfield, IL 62703 | 2017-09-04 |
| 1477006161 | Encompass Home Health of The Midwest,llc | Home Health | 2970 Baker Dr, Springfield, IL 62703 | 2016-07-28 |
| 1851706824 | Terah Louise Holland | Obstetrics & Gynecology | 1100 E Lincolnshire Blvd Ste 200, Springfield, IL 62703 | 2014-06-27 |
| 1578993101 | Corey Moore | Behavioral Analyst | 5520 South 6th Street Road, Suite 1700, Springfield, IL 62703 | 2013-11-18 |
| 1134463052 | The Center for Youth and Family Solutions Inc. | Voluntary or Charitable | 614 North Sixth Street, Springfield, IL 62703 | 2012-11-15 |
| 1447519111 | Tenshi Furumi | Specialist/Technologist | One University Plaza, Univ. of Illinois-springfield, Ms Rec 2004, Springfield, IL 62703 | 2012-05-15 |
| 1447558390 | Shalini Mulkanoor | Family Medicine | 1100 E. Lincolnshire Blvd., Suite 200, Springfield, IL 62703 | 2011-03-02 |
| Find all providers in zip 62703 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053958439 | Cumberland Family Medical Center, Inc. | Clinic/Center | 601 Lincoln Park Rd, Springfield, KY 40069-1501 | 2019-12-05 |
| 1144867524 | Cumberland Family Medical Center, Inc. | Clinic/Center | 300 W Us Hwy 150 Bypass, Springfield, KY 40069-8460 | 2019-12-05 |
| 1275170680 | Cumberland Family Medical Center, Inc | Clinic/Center | 603 Lincoln Park Rd, Springfield, KY 40069-1501 | 2019-12-04 |
| 1407490741 | Advocates for A Healthy Community Inc | Clinic/Center | 2238 W Kingsley St, Springfield, MO 65807-5456 | 2019-10-30 |
| 1447768569 | Springfield Medical Care Systems Inc | Clinic/Center | 43 Union St, Springfield, VT 05156-3133 | 2018-01-11 |
| 1457869570 | Springfield Medical Care Systems Inc | Clinic/Center | 10 Hoover St, Springfield, VT 05156-2425 | 2018-01-11 |
| 1356859474 | Springfield Medical Care Systems Inc | Clinic/Center | 303 South St, Springfield, VT 05156-3226 | 2018-01-11 |
| 1508373655 | Springfield Medical Care Systems Inc | Clinic/Center | 13 Fairground Rd, Springfield, VT 05156-2112 | 2018-01-10 |
| 1861911893 | Central Counties Health Centers, Inc. | Clinic/Center | 5220 6th Street Frontage Rd E Ste 2400, Springfield, IL 62703-5761 | 2017-09-11 |
| 1467976001 | Greater Philadelphia Health Action Inc. | Clinic/Center | 1489 Baltimore Pike, Building 300, Suite 300, The Mills of Victoria, Springfield, PA 19064-6024 | 2017-07-26 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62703 |
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.