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BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY 1770259764

Overview
Name: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY Specialty: Federally Qualified Health Center (FQHC) Type of Practice: Organization Provider/Org: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY Medical School: Graduation year from medical school: Affiliation:
Specialties
Practice Type: Ambulatory Health Care Facilities Classification: Clinic/Center Specialization: Federally Qualified Health Center (FQHC). Definition of Specialty: Definition to come…
License & NPI
License #(s): , , , , License State(s): , , , ,
Addresses
Practice Location: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY,1600 E CLEAR LAKE AVE STE 120,SPRINGFIELD,IL,627031172,US Mailing Address: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY,201 E MADISON ST STE 328,SPRINGFIELD,IL,627025131,US
Contact #
Practice location phone #: 2175458000 Practice location fax #: Mailing address Phone #: 2175456523 Mailing Address fax #: Authorized official Name/Telephone #:SHELBY, RENEE, BURDICK, TEAM LEAD, MEDICAL STAFF 2175456523
Misc
Date NPI was obtained: 08/19/2021 Last data data was updated: 08/19/2021 Insurances:

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