| Board Of Trustees Of Southern Illinois University | |
|
300 W Oak St Ste 100 Carbondale IL 62901-1496 | |
| (618) 536-6621 | |
| Not Available |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 300 W Oak St Ste 100, Carbondale, Illinois |
| Authorized Official Name and Position | Iris Wesley (CEO) |
| Authorized Official Contact | 2175458000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of Southern Illinois University Po Box 19639 Springfield IL 62794-9639 Ph: (217) 545-7876 | Board Of Trustees Of Southern Illinois University 300 W Oak St Ste 100 Carbondale IL 62901-1496 Ph: (618) 536-6621 |
| NPI Number | 1396386181 |
|---|---|
| Provider Enumeration Date | 10/02/2019 |
| Last Update Date | 10/02/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396386181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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