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Contact Information

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
425 E STATE ST., STE 100
JACKSONVILLE, IL62650-2125
 Phone: 217-408-1195
 Fax: 217-408-1231
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Federally Qualified Health Center (FQHC)

261QF0400X B4[14] Federally Qualified Health Center
 

Primary Care

261QP2300X
Indicates primary specialty

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

NPI # 1598412447
LBN Legal business name BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official IRIS WESLEY - (CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/09/2022
Last updated 01/09/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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