| NPI | 1104230168 |
|---|---|
| Doing Business As | SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE |
| Entity Type | Organization |
| Authorized Contact | MYJAL GARNER Director 618-482-6959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2025-01-08 |