BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

SPRINGFIELD, IL
NPI1770259764
Doing Business AsSIU CENTER FOR FAMILY MEDICINE - GIM SALVATION ARMY
Entity TypeOrganization
Authorized ContactIRIS WESLEY
CEO
217-545-8000
Organization Subpart ?Yes
Primary Taxonomy261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC)
Additional Taxonomies261QP2300X Clinic/Center, Primary Care
Enumeration Date2021-08-19
Last Update Date2025-01-09
Business Address
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
1600 E CLEAR LAKE AVE STE 120
SPRINGFIELD, IL 62703-1172
Phone number: 217-545-8000
Mailing Address
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
PO BOX 19639
SPRINGFIELD, IL 62794-9639
Phone number: 217-545-6523