Eastern Illinois University Health Service

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

License

E9988478107 Issued in IL

Legal business name

EASTERN ILLINOIS UNIVERSITY HEALTH SERVICE

Practice address

600 Lincoln Ave
Eastern Illinois University
Charleston, IL 61920-3011

Phone

(217) 581-3015

Fax

(217) 581-3899

NPI assigned

May 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sheila D Baker, MD

Title

Medical Director

Phone

(217) 581-3015

Specialties & licenses 1

Addresses

Tax ID family

Board of Trustees for Eastern Illinois University2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Board of Trustees for Eastern Illinois University

  dba Eastern Il University Pharmacy

  • Clinic Pharmacy
  • Charleston, IL
  • NPI 1457434532
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104030790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 LINCOLN AVE",
            "address_2": "EASTERN ILLINOIS UNIVERSITY",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203011",
            "telephone_number": "217-581-3015",
            "fax_number": "217-581-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 LINCOLN AVE",
            "address_2": "EASTERN ILLINOIS UNIVERSITY",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203011",
            "telephone_number": "217-581-3015",
            "fax_number": "217-581-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN ILLINOIS UNIVERSITY HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "217-581-3015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "IL",
            "license": "E9988478107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra J Durham, OTR
• Darcy L Duzan, O.D.
• Dva Renal Healthcare Inc (Mattoon Dialysis)
• Dynamic Homecare Inc
• Eastern Illinois Area of Special Education
• Crystal Edwards
• David Jedidiah Ehlers, LCPC
• Francesca Lynn Ehlers, MS
• Eiu Speech Language Hearing Clinic
• Mark Emenecker, D.O.

• Student Health Clinic/Center in Charleston, IL
• Providers in Charleston, IL by specialty
• Student Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.