| Board Of Trustees Of Southern Illinois University | |
|
300 W Oak St Carbondale IL 62901-1400 | |
| (618) 536-6621 | |
| (618) 453-1102 |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/Center |
| Location | 300 W Oak St, Carbondale, Illinois |
| Authorized Official Name and Position | Iris Wesley (CEO) |
| Authorized Official Contact | 2175458000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of Southern Illinois University Po Box 19639 Springfield IL 62794-9639 Ph: (217) 545-7578 | Board Of Trustees Of Southern Illinois University 300 W Oak St Carbondale IL 62901-1400 Ph: (618) 536-6621 |
| NPI Number | 1437708674 |
|---|---|
| Provider Enumeration Date | 09/10/2019 |
| Last Update Date | 01/09/2025 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20191008000423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437708674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Southern Illinois University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 374 East Grand Avenue, Mail Code 674d, Carbondale, IL 62901 Phone: 618-453-3311 Fax: 618-453-4449 | |
The Carbondale Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2601 W Main St, Carbondale, IL 62901 Phone: 618-457-5200 Fax: 618-549-5128 | |
Community Health & Emergency Services, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1250 Cedar Ct, Carbondale, IL 62901 Phone: 618-351-1213 Fax: 618-351-1905 | |
Southern Illinois Gi Specialists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1100 W Diann Ln, Carbondale, IL 62901 Phone: 618-549-8006 Fax: 618-549-8434 | |
Carbondale Community High Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 S Giant City Rd, Carbondale, IL 62902 Phone: 618-457-4722 Fax: 618-457-3353 | |
Southern Illinois Medical Services, Nfp Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2601 W Main St, Carbondale, IL 62901 Phone: 618-549-5361 Fax: 618-351-4878 | |
Brown's Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 W Jackson St, Carbondale, IL 62901 Phone: 618-351-9559 |