NPI | 1437708674 |
---|---|
Doing Business As | SIU CENTER FOR FAMILY MEDICINE - CARBONDALE |
Entity Type | Organization |
Authorized Contact | IRIS WESLEY CEO 217-545-8000 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
Enumeration Date | 2019-09-10 |
Last Update Date | 2025-01-09 |