BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1396097960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396097960 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Other Organization Name | SIU CENTER FOR FAMILY MEDICINE |
| Practice Address |
520 N 4th St Springfield IL 62702-5238 |
| Mailing Address |
Po Box 19670 Springfield IL 62794-9670 |
| Practice Telephone | 2177578100 |
| Practice Fax Number | 2177471351 |
| Mailing Telephone | 2177578100 |
| Mailing Fax Number | 2177471351 |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2013-03-14 |
| Authorized Official Name | JANET R ALBERS (CEO) |
| Authorized Official Telephone | 2177578100 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SIU CENTER FOR FAMILY MEDICINE | 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 |
| 1003324260 | Board of Trustees of Southern Illinois University | Clinic/Center | 4409 Maine St Ste 100, Quincy, IL 62305-5849 | 2018-01-22 |
| 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 |
| Street Address |
520 N 4TH ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-5238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023006913 | Janet R Albers | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2005-10-13 |
| 1316559529 | Andrea Dawn Peterson | Social Worker | 520 N 4th St, Springfield, IL 62702-5238 | 2020-08-19 |
| 1811505159 | Naila Manahil | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-07-22 |
| 1881211605 | Roxanne Bautista | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-06-27 |
| 1689298366 | Ibukunoluwa Oluwatoni Olapoju | Family Medicine | 520 N 4th St, Springfield, IL 62702 | 2020-05-29 |
| 1386267425 | George Hudson | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-05-23 |
| 1962025577 | Logan Tyler Garthe | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-05-19 |
| 1740802693 | Haroun Babajide Ogun | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-05-14 |
| 1952923153 | Hayley Hudson | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-05-11 |
| 1780206094 | Patrick Hale Long | Family Medicine | 520 N 4th St, Springfield, IL 62702-5238 | 2020-05-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730790874 | Janice G. Sadaya-conda M.d., Pllc | Clinic/Center | 6128 Brandon Ave Ste 225, Springfield, VA 22150-2640 | 2020-08-12 |
| 1639612880 | Icco LLC | Clinic/Center | 5781 Main Street, Springfield, OR 97478 | 2016-11-21 |
| 1164841912 | Yellow Springs Primary Care, Inc | Clinic/Center | 2608 E High St, Springfield, OH 45505-1454 | 2014-04-09 |
| 1891125480 | Western Massachusetts Primary Care PC | Clinic/Center | 405 Armory St, Springfield, MA 01104-2305 | 2013-11-18 |
| 1629364351 | Spring Valley Family Care | Clinic/Center | 27 Springfield Pike, Springfield, WV 26763 | 2011-06-21 |
| 1881193670 | 417 Health & Wellness | Clinic/Center | 1850 S Stewart Ave, Springfield, MO 65804-2519 | 2018-02-07 |
| 1588057533 | Quest Primary Care LLC | Clinic/Center | 1176 E Home Rd, Springfield, OH 45503-2726 | 2015-03-16 |
| 1851718712 | Community Health Clinic Pllc | Clinic/Center | 80 Congress St, Springfield, MA 01104-3564 | 2014-03-27 |
| 1518309426 | Burton Hills Primary Care, LLC | Clinic/Center | 2662 Memorial Blvd, Springfield, TN 37172 | 2013-07-19 |
| 1922350099 | Board of Trustees of Southern Illinois University | Clinic/Center | 5220 S 6th Street Rd, Suite 1200, Springfield, IL 62703-5735 | 2012-10-12 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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.