NPI:
1003324260
Provider Name:
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Doing Business As: SIU CENTER FOR FAMILY MEDICINE - TRANSITIONS OF WESTERN ILLINOIS
Classification:
Clinic/Center - 261QF0400X
Entity Type:
Organization
Specialization: Federally Qualified Health Center (FQHC)
Address:
4409 MAINE ST STE 100
QUINCY, IL
ZIP 62305
Phone:
(217) 919-9139
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BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY is a federally qualified health center (fqhc) clinic center in Quincy, IL. BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY NPI is 1003324260. The provider is registered as an organization entity type.
The provider Is Doing Business As Siu Center For Family Medicine - Transitions Of Western Illinois.
The provider's business location address is:
4409 MAINE ST STE 100
QUINCY, IL
ZIP 62305-849
Phone: (217) 919-9139
Fax: (217) 223-0461
The provider's authorized official is Iris Wesley .
The authorized official title is Ceo and has the following contact phone number (217) 545-8000.
The enumeration date for this NPI number is 1/22/2018 and was last updated on 1/22/2018.