BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY


Address: 109 3rd St, Lincoln, IL 62656-2604
Phone: 2175457876

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1972049641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1972049641
Entity Type Organization
Organization Name BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other Organization Name SIU CENTER FOR FAMILY MEDICINE - LINCOLN
Practice Address 109 3rd St
Lincoln
IL 62656-2604
Practice Telephone 2175457876
Practice Fax Number 2175454410
Mailing Telephone 2175457876
Mailing Fax Number 2175454410
Enumeration Date 2017-01-18
Last Update Date 2017-01-18
Authorized Official Name IRIS WESLEY (CEO)
Authorized Official Telephone 2175457876
Is Organization Subpart Y
Parent Organization Name BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Taxonomy

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 Provider/Organization Names

Other Name Type Code
SIU Center for Family Medicine - Lincoln Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 109 3RD ST
City LINCOLN
State IL
Zip Code 62656-2604

Providers in the same location

NPI Name Taxonomy Address Enumeration
1790785186 County of Logan Public Health or Welfare 109 3rd St, Lincoln, IL 62656-0508 2005-07-28
1073925723 Kelly Eileen Crooks Social Worker 109 3rd St, Lincoln, IL 62656 2014-05-29
1881823011 Sharon Elizabeth Molitoris Dentist 109 3rd St, Lincoln, IL 62656-2604 2009-07-09
1073762290 County of Logan Public Health or Welfare 109 3rd St, Lincoln, IL 62656-2604 2008-09-11

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437678943 Carissa Jo O'donoghue Speech-Language Pathologist 1000 Railer Way, Lincoln, IL 62656 2017-09-15
1083972012 Cynthia Dorchinecz Speech-Language Pathologist 200 Fifth Street, Lincoln, IL 62656 2012-04-27
1104100114 Jan E Fehrenbacher Pharmacist 603 Woodlawn, Lincoln, IL 62656 2011-10-10
1053633263 Tazwood Mental Health Center, Inc. Community/Behavioral Health 124-126 S. Chicago Street, Lincoln, IL 62656 2010-02-16
1649428756 Diane E Ulrich Dentist 400 N. Chicago St, Lincoln, IL 62656 2008-09-03
1922202944 Robert C Miller Dentist 217 S Kickapoo St, Lincoln, IL 62656 2007-06-13
1720290638 Lifetime Dental Care of Illinois, PC Dentist 411 Keokuk Street, Lincoln, IL 62656 2007-05-04
1982734539 Wal-mart Stores, Inc. Dba Wal-mart Technician/Technologist 825 Malerich Dr., Lincoln, IL 62656 2007-03-06
1861571663 David R Hepler II Chiropractor 2000 Pulaski Street, Lincoln, IL 62656 2006-11-03
1477561793 Raymond Todd Nobbe Optometrist 1400 Woodlawn Road, Lincoln, IL 62656 2006-08-03
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Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1184194557 Bluestem Health Clinic/Center 3100 N 14th St Ste 201, Lincoln, NE 68521-2134 2018-11-28
1053714295 St Francis House Nwa, Inc Clinic/Center 201 E School St, Lincoln, AR 72744-8885 2014-10-02

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1417567108 Pillars Community Health Clinic/Center 15w458 91st St, Burr Ridge, IL 60527-6379 2020-08-06
1932724390 Friend Family Health Center, Inc Clinic/Center 7355 S Jeffery Blvd, Chicago, IL 60649-3121 2020-06-11
1871117937 Primecare Community Health Inc Clinic/Center 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 2020-06-04
1639791569 Community Health Partnership of Illinois Clinic/Center 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 2020-05-14
1407482219 Access Community Health Network Clinic/Center 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 2020-03-13
1235769704 Greater Elgin Family Care Center Clinic/Center 451 N Mclean Blvd, Elgin, IL 60123-3239 2020-01-23
1710517537 Greater Elgin Family Care Center Integrated Health Home Clinic/Center 1100 Shirley Ave, Streamwood, IL 60107-3068 2020-01-21
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
1427600345 The Board of Trustees of The University of Illinois Clinic/Center 6835 S Normal Blvd, Chicago, IL 60621-2535 2019-07-11
Find all providers with the same taxonomy

Competitor

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City LINCOLN
Zip Code 62656

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Dataset Information

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.

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