institution
Board Of Trustees Of Southern Illinois University
Federally Qualified Health Center (FQHC) in Decatur, Illinois
NPI 1407376338

Board Of Trustees Of Southern Illinois University is a Federally Qualified Health Center (FQHC) based in Springfield, IL and is specialized in Federally Qualified Health Center (FQHC). Board Of Trustees Of Southern Illinois University practices in Decatur, IL. The NPI Number for Board Of Trustees Of Southern Illinois University is 1407376338 and holds a License No. (Illinois).

The current practice location address for Board Of Trustees Of Southern Illinois University is 102 W Kenwood Ave, Decatur, IL and can be reached out via phone at 217-872-3800 and via fax at 217-872-0849.

Location: 102 W Kenwood Ave, Decatur, IL, 62794-9639
institution
Provider Profile Details
NPI Number
1407376338
Provider Name
Board Of Trustees Of Southern Illinois University
Credential
Provider Entity Type
Organization
Address
102 W Kenwood Ave, Decatur, IL, 62794-9639
Phone Number
217-872-3800
Fax Number
217-872-0849
Provider Enumeration Date
06/21/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
102 W Kenwood Ave
City
State
Zip
62526-4368
Phone Number
217-872-3800
Fax Number
217-872-0849
person
Provider Business Mailing Address Details
Address
102 W Kenwood Ave
City
State
Zip
62526-4368
Phone Number
217-872-3800
Fax Number
217-872-0849
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Federally Qualified Health Center (FQHC)
Taxonomy
License No.
(Illinois)
Definition
Definition to come...
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