Board of Trustees of Southern Illinois University
Organization Active NPI Federally Qualified Health Center (FQHC) · Quincy, IL
NPI 1922515451 · NPPES record last updated Jan 5, 2018
Key facts
- NPI
- 1922515451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
- Practice address
- 330 Vermont St Ste 211
Quincy, IL 62301-2700 - Phone
- (217) 222-8440
- NPI assigned
- Jan 5, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Authorized official
- Name
- Iris Wesley
- Title
- Ceo
- Phone
- (217) 545-8000
Corporate family (same tax ID) 28
National Provider Directory
- Tax ID family
- DRS Herald and Thompson
- Part of
- DRS Herald and Thompson
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
330 Vermont St Ste 211
Quincy, IL 62301-2700
Mailing address
PO Box 19639
Springfield, IL 62794-9639
Other names
- SIU Quincy/Adams County Health Wellness Express
Other providers in Quincy, IL
- Board of Trustees of Southern Illinois University
- Board of Trustees of Southern Illinois University
- Board of Trustees of Southern Illinois University
- Board of Trustees of Southern Illinois University
- Board of Trustees of Southern Illinois University
- Michelle Boatman
- Ta'Meika Boatman
- Kaylee Bock
- Sarah K Bockhold
- Daniel Theodore Boeder
All providers in Quincy, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.