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: