National Provider Identifier Database

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Federally Qualified Health Center (FQHC)

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.


Contact Information

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
102 W KENWOOD AVE
DECATUR, IL62526-4368
Phone: 217-872-3800
Fax: 217-872-0849
Website:
Specialty Taxonomy Code
* Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

NPI Number 1407376338
Legal business name
LBN
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official IRIS WESLEY - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart Yes
Enumeration date 06/21/2017
Last updated 01/09/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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