NPIMap

Organization Active NPI

Board of Trustees of Southern Illinois University

Doing business as SIU Quincy Family Medicine

  • Health Educator
  • Quincy, IL
National Provider Identifier
1730826165
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Doing business as
SIU Quincy Family Medicine
SIU Quincy Family Medicine - ADCES Program
Practice address
612 N 11TH St
Quincy, IL 62301-2662
Phone
(217) 224-9484
Fax
(217) 224-7950
NPI assigned
May 17, 2022
Last updated
May 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Authorized official

Name
Iris Wesley
Title
Ceo
Phone
(217) 757-8137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Educator 174H00000X Primary

Addresses

Primary practice location

612 N 11TH St
Quincy, IL 62301-2662

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Other names 2

  • SIU Quincy Family Medicine Doing business as
  • SIU Quincy Family Medicine - ADCES Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Invalid Entry29 organizations share this tax ID, including this one
Part of
Invalid Entry

Other organizations with this tax ID 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1730826165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N 11TH ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012662",
            "telephone_number": "217-224-9484",
            "fax_number": "217-224-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "WESLEY",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-757-8137"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIU Quincy Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SIU Quincy Family Medicine - ADCES Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.