BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1003324260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003324260 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Other Organization Name | SIU CENTER FOR FAMILY MEDICINE - TRANSITIONS OF WESTERN ILLINOIS |
| Practice Address |
4409 Maine St Ste 100 Quincy IL 62305-5849 |
| Mailing Address |
Po Box 19639 Springfield IL 62794-9639 |
| Practice Telephone | 2179199139 |
| Practice Fax Number | 2172230461 |
| Mailing Telephone | 2175457876 |
| Mailing Fax Number | 2175454410 |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2018-01-22 |
| Authorized Official Name | IRIS WESLEY (CEO) |
| Authorized Official Telephone | 2175458000 |
| Is Organization Subpart | Y |
| Parent Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SIU Center for Family Medicine - Transitions of Western Illinois | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396386181 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak St Ste 100, Carbondale, IL 62901-1496 | 2019-10-02 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1558848473 | Board of Trustees of Southern Illinois University | Clinic/Center | 2833 S Grand Ave E Ste 100, Springfield, IL 62703-2175 | 2018-07-24 |
| 1083121537 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 100, Quincy, IL 62301-2700 | 2018-01-05 |
| 1922515451 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 211, Quincy, IL 62301-2700 | 2018-01-05 |
| 1679188437 | Board of Trustees of Southern Illinois University | Clinic/Center | 751 N Rutledge St Ste 1100, Springfield, IL 62702-4968 | 2020-09-09 |
| 1619501871 | Board of Trustees of Southern Illinois University | Clinic/Center | 606 W Adams St, Pittsfield, IL 62363-1308 | 2020-02-26 |
| 1851934871 | Board of Trustees of Southern Illinois University | Clinic/Center | 303 E Bidwell St, Taylorville, IL 62568-1363 | 2019-10-22 |
| 1023585312 | Board of Trustees of Southern Illinois University | Clinic/Center | 2833 S Grand Ave E, Springfield, IL 62703-2175 | 2018-10-25 |
| Street Address |
4409 MAINE ST STE 100 |
| City | QUINCY |
| State | IL |
| Zip Code | 62305-5849 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386999001 | Kristi Michelle Gillette | Internal Medicine | 5011 Oak St, Quincy, IL 62305 | 2012-07-18 |
| 1447582549 | Cathi Marie Webb | Counselor | 3701 E Lake Center Dr, Suite # 8 The Shaw Building, Quincy, IL 62305 | 2010-02-01 |
| 1285804450 | Curtis D Fauble | Dentist | 4561 Maine, Quincy, IL 62305 | 2008-03-04 |
| 1598940256 | Kelley Jo Begeman | Licensed Practical Nurse | 934 North 1903 Road Lane, Quincy, IL 62305 | 2007-12-31 |
| 1649459470 | Aa Dental Care PC | Dentist | 407 So 48th Street, Quincy, IL 62305 | 2007-10-29 |
| 1982803920 | Dennis Ryan Wagner | Dentist | 407 South 48th St, Quincy, IL 62305 | 2007-07-11 |
| 1689899056 | Capelle House | Day Training, Developmentally Disabled Services | 3325 Ghost Hollow Road, Quincy, IL 62305 | 2007-04-13 |
| 1750416236 | Julie A Danker | Social Worker | 2209 N 64th St, Quincy, IL 62305 | 2007-02-23 |
| 1942812300 | Brooke N Bracy | Dentist | 4561 Maine, Quincy, IL 62305 | 2020-08-18 |
| 1558997379 | Blessing Corporate Services, Inc | Clinic/Center | 4800 Maine St, Quincy, IL 62305 | 2020-03-13 |
| Find all providers in zip 62305 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1083121537 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 100, Quincy, IL 62301-2700 | 2018-01-05 |
| 1922515451 | Board of Trustees of Southern Illinois University | Clinic/Center | 330 Vermont St Ste 211, Quincy, IL 62301-2700 | 2018-01-05 |
| 1275012353 | Quincy Community Health Center | Clinic/Center | 1450 1st Ave Sw, Quincy, WA 98848-1695 | 2018-08-09 |
| 1376921924 | Board of Trustees of Southern Illinois University | Clinic/Center | 612 N 11th St, Quincy, IL 62301-2662 | 2015-05-15 |
| 1336382944 | Boston Health Care for The Homeless Program, Inc. | Clinic/Center | 38 Broad St, Quincy, MA 02169 | 2009-04-13 |
| 1528214756 | Moses Lake Community Health Center | Clinic/Center | 1450 1st Ave Sw, Quincy, WA 98848-1695 | 2008-08-07 |
| 1376574103 | Manet Community Health Center, Inc. | Clinic/Center | 1193 Sea St, Quincy, MA 02169-3544 | 2006-07-06 |
| 1093746828 | Manet Community Health Center, Inc. | Clinic/Center | 114 Whitwell St, 2nd Floor, Quincy, MA 02169-1870 | 2006-07-06 |
| 1891731956 | Manet Community Health Center, Inc. | Clinic/Center | 9 Bicknell St, Quincy, MA 02169-6003 | 2006-06-20 |
| Find all providers in QUINCY | ||||
Please comment or provide details below to improve the information on BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.