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BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY NPI 1558539882


NPI Information

NPI: 1558539882
Provider Name: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Doing Business As: DEPARTMENT OF PSYCHIATRY

Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 14D1076391

Address:
901 W JEFFERSON ST
SPRINGFIELD, IL
ZIP 62702
Phone: (217) 545-8229
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BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY is a community behavioral health in Springfield, IL. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY NPI is 1558539882. The provider is registered as an organization entity type.
The provider Is Doing Business As Department Of Psychiatry.

The provider's business location address is:

901 W JEFFERSON ST
SPRINGFIELD, IL
ZIP 62702-833
Phone: (217) 545-8229
Fax: (217) 545-2275

The provider's authorized official is David J Tkach .
The authorized official title is Ceo and has the following contact phone number (217) 545-7578.

The CLIA number assigned to this NPI record is 14D1076391 - other - state univ medical school with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 2/20/2008 and was last updated on 6/19/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral Health10-0066401ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100066401002MEDICAIDILLINOIS
2=========011MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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