BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY NPI 1972049641

NPI Information

NPI: 1972049641
Provider Name: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Doing Business As: SIU CENTER FOR FAMILY MEDICINE - LINCOLN

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
109 3RD ST
LINCOLN, IL
ZIP 62656
Phone: (217) 545-7876
Get Directions

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY is a federally qualified health center (fqhc) clinic center in Lincoln, IL. BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY NPI is 1972049641. The provider is registered as an organization entity type.
The provider Is Doing Business As Siu Center For Family Medicine - Lincoln.

The provider's business location address is:

109 3RD ST
LINCOLN, IL
ZIP 62656-604
Phone: (217) 545-7876
Fax: (217) 545-4410

The provider's authorized official is Iris Wesley .
The authorized official title is Ceo and has the following contact phone number (217) 545-7876.

The CLIA number assigned to this NPI record is 14D2124063 - other - state univ lab with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2017 and was last updated on 1/18/2017.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

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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