BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY (NPI# 1972049641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1972049641 |
Entity Type | Organization |
Organization Name | BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY |
Other Organization Name | SIU CENTER FOR FAMILY MEDICINE - LINCOLN |
Practice Address |
109 3rd St Lincoln IL 62656-2604 |
Practice Telephone | 2175457876 |
Practice Fax Number | 2175454410 |
Mailing Telephone | 2175457876 |
Mailing Fax Number | 2175454410 |
Enumeration Date | 2017-01-18 |
Last Update Date | 2017-01-18 |
Authorized Official Name | IRIS WESLEY (CEO) |
Authorized Official Telephone | 2175457876 |
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 - Lincoln | 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 |
109 3RD ST |
City | LINCOLN |
State | IL |
Zip Code | 62656-2604 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790785186 | County of Logan | Public Health or Welfare | 109 3rd St, Lincoln, IL 62656-0508 | 2005-07-28 |
1073925723 | Kelly Eileen Crooks | Social Worker | 109 3rd St, Lincoln, IL 62656 | 2014-05-29 |
1881823011 | Sharon Elizabeth Molitoris | Dentist | 109 3rd St, Lincoln, IL 62656-2604 | 2009-07-09 |
1073762290 | County of Logan | Public Health or Welfare | 109 3rd St, Lincoln, IL 62656-2604 | 2008-09-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437678943 | Carissa Jo O'donoghue | Speech-Language Pathologist | 1000 Railer Way, Lincoln, IL 62656 | 2017-09-15 |
1083972012 | Cynthia Dorchinecz | Speech-Language Pathologist | 200 Fifth Street, Lincoln, IL 62656 | 2012-04-27 |
1104100114 | Jan E Fehrenbacher | Pharmacist | 603 Woodlawn, Lincoln, IL 62656 | 2011-10-10 |
1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
1649428756 | Diane E Ulrich | Dentist | 400 N. Chicago St, Lincoln, IL 62656 | 2008-09-03 |
1922202944 | Robert C Miller | Dentist | 217 S Kickapoo St, Lincoln, IL 62656 | 2007-06-13 |
1720290638 | Lifetime Dental Care of Illinois, PC | Dentist | 411 Keokuk Street, Lincoln, IL 62656 | 2007-05-04 |
1982734539 | Wal-mart Stores, Inc. Dba Wal-mart | Technician/Technologist | 825 Malerich Dr., Lincoln, IL 62656 | 2007-03-06 |
1861571663 | David R Hepler II | Chiropractor | 2000 Pulaski Street, Lincoln, IL 62656 | 2006-11-03 |
1477561793 | Raymond Todd Nobbe | Optometrist | 1400 Woodlawn Road, Lincoln, IL 62656 | 2006-08-03 |
Find all providers in zip 62656 |
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 |
---|---|---|---|---|
1184194557 | Bluestem Health | Clinic/Center | 3100 N 14th St Ste 201, Lincoln, NE 68521-2134 | 2018-11-28 |
1053714295 | St Francis House Nwa, Inc | Clinic/Center | 201 E School St, Lincoln, AR 72744-8885 | 2014-10-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417567108 | Pillars Community Health | Clinic/Center | 15w458 91st St, Burr Ridge, IL 60527-6379 | 2020-08-06 |
1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
1639791569 | Community Health Partnership of Illinois | Clinic/Center | 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 | 2020-05-14 |
1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
1235769704 | Greater Elgin Family Care Center | Clinic/Center | 451 N Mclean Blvd, Elgin, IL 60123-3239 | 2020-01-23 |
1710517537 | Greater Elgin Family Care Center Integrated Health Home | Clinic/Center | 1100 Shirley Ave, Streamwood, IL 60107-3068 | 2020-01-21 |
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 |
1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
Find all providers with the same taxonomy |
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.