BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY


Address: 5220 S 6th Street Rd, Suite 1500, Springfield, IL 62703-5735
Phone: 2175458000

BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1518343722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1518343722
Entity Type Organization
Organization Name BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Other Organization Name SIU CENTER FOR FAMILY MEDICINE - NOLL
Practice Address 5220 S 6th Street Rd
Suite 1500
Springfield
IL 62703-5735
Mailing Address Po Box 19670
Springfield
IL 62794-9670
Practice Telephone 2175458000
Practice Fax Number 2177471351
Mailing Telephone 2175458000
Mailing Fax Number 2177471351
Enumeration Date 2015-08-11
Last Update Date 2015-08-13
Authorized Official Name IRIS WESLEY (CEO/FQHC DIRECTOR)
Authorized Official Telephone 2175458000
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
IL Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
SIU CENTER FOR FAMILY MEDICINE - NOLL Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 5220 S 6TH STREET RD
SUITE 1500
City SPRINGFIELD
State IL
Zip Code 62703-5735

Providers in the same location

NPI Name Taxonomy Address Enumeration
1336168269 Hetal A Shah Physical Therapist 5220 S 6th Street Rd, Suite 1500, Springfield, IL 62703-5735 2006-07-19
1376093740 Stephanie Nicole Fahey Speech-Language Pathologist 5220 S 6th Street Rd, Suite 1700 (noll Medical Pavillion, The Autism Clinic), Springfield, IL 62703-5735 2016-10-10
1285096560 Meika Valerio Behavioral Analyst 5220 S 6th Street Rd, Suite 1700, Springfield, IL 62703-5735 2016-03-24
1770941957 Katherine Docter Behavioral Analyst 5220 S 6th Street Rd, Springfield, IL 62703-5735 2016-02-03
1619332541 Angela Westwood Speech-Language Pathologist 5220 S 6th Street Rd, Ste. 1700, Springfield, IL 62703-5735 2015-12-18
1962877571 Anne Marie Wingbermuehle Behavioral Analyst 5220 S 6th Street Rd, Suite 1700, Springfield, IL 62703-5735 2015-12-08
1528432119 The Hope School Dba The Autism Clinic Counselor 5220 S 6th Street Rd, Suite 1700, Springfield, IL 62703-5735 2015-11-19
1457774416 Brianne Satorius Counselor 5220 S 6th Street Rd, Suite 2400, Springfield, IL 62703-5735 2014-01-28
1114358199 Jamie Lee Blakeman Counselor 5220 S 6th Street Rd, Suite 2400, Springfield, IL 62703-5735 2013-12-02
1982049508 The Baby Fold Foster Care Agency 5220 S 6th Street Rd, Springfield, IL 62703-5735 2013-05-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1790260917 Jessica Lynne Zeeck Behavior Technician 5220 6th Street Frontage Road, E Suite 1700, Springfield, IL 62703 2018-10-03
1215415799 Bree Schmulbach Nurse Practitioner Bsb Room 20, Springfield, IL 62703 2018-08-06
1144712100 Fresenius Medical Care Springfield East, LLC Clinic/Center 140 S. Martin Luther King Jr. Drive, Springfield, IL 62703 2018-06-05
1558889170 Ji Woung Choi Dentist 687 E Linton Ave., Springfield, IL 62703 2017-09-04
1477006161 Encompass Home Health of The Midwest,llc Home Health 2970 Baker Dr, Springfield, IL 62703 2016-07-28
1851706824 Terah Louise Holland Obstetrics & Gynecology 1100 E Lincolnshire Blvd Ste 200, Springfield, IL 62703 2014-06-27
1578993101 Corey Moore Behavioral Analyst 5520 South 6th Street Road, Suite 1700, Springfield, IL 62703 2013-11-18
1134463052 The Center for Youth and Family Solutions Inc. Voluntary or Charitable 614 North Sixth Street, Springfield, IL 62703 2012-11-15
1447519111 Tenshi Furumi Specialist/Technologist One University Plaza, Univ. of Illinois-springfield, Ms Rec 2004, Springfield, IL 62703 2012-05-15
1447558390 Shalini Mulkanoor Family Medicine 1100 E. Lincolnshire Blvd., Suite 200, Springfield, IL 62703 2011-03-02
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Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1053958439 Cumberland Family Medical Center, Inc. Clinic/Center 601 Lincoln Park Rd, Springfield, KY 40069-1501 2019-12-05
1144867524 Cumberland Family Medical Center, Inc. Clinic/Center 300 W Us Hwy 150 Bypass, Springfield, KY 40069-8460 2019-12-05
1275170680 Cumberland Family Medical Center, Inc Clinic/Center 603 Lincoln Park Rd, Springfield, KY 40069-1501 2019-12-04
1407490741 Advocates for A Healthy Community Inc Clinic/Center 2238 W Kingsley St, Springfield, MO 65807-5456 2019-10-30
1558848473 Board of Trustees of Southern Illinois University Clinic/Center 2833 S Grand Ave E Ste 100, Springfield, IL 62703-2175 2018-07-24
1447768569 Springfield Medical Care Systems Inc Clinic/Center 43 Union St, Springfield, VT 05156-3133 2018-01-11
1457869570 Springfield Medical Care Systems Inc Clinic/Center 10 Hoover St, Springfield, VT 05156-2425 2018-01-11
1356859474 Springfield Medical Care Systems Inc Clinic/Center 303 South St, Springfield, VT 05156-3226 2018-01-11
1508373655 Springfield Medical Care Systems Inc Clinic/Center 13 Fairground Rd, Springfield, VT 05156-2112 2018-01-10
1861911893 Central Counties Health Centers, Inc. Clinic/Center 5220 6th Street Frontage Rd E Ste 2400, Springfield, IL 62703-5761 2017-09-11
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Competitor

Search similar providers

City SPRINGFIELD
Zip Code 62703

Improve Information

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Dataset Information

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.

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