BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1922350099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922350099 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
| Other Organization Name | NOLL MEDICAL PAVILION CLINIC |
| Practice Address |
5220 S 6th Street Rd Suite 1200 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 | 2012-10-12 |
| Last Update Date | 2013-03-14 |
| Authorized Official Name | DR. JANET R ALBERS (DIRECTOR) |
| 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 |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| NOLL MEDICAL PAVILION CLINIC | 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 |
5220 S 6TH STREET RD SUITE 1200 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62703-5735 |
| 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 |
| 1518343722 | Board of Trustees of Southern Illinois University | Clinic/Center | 5220 S 6th Street Rd, Suite 1500, Springfield, IL 62703-5735 | 2015-08-11 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 62703 | ||||
| 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 |
| 1396097960 | Board of Trustees of Southern Illinois University | Clinic/Center | 520 N 4th St, Springfield, IL 62702-5238 | 2012-10-08 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62703 |
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.