| Southern Illinois University | |
|
601 James R Thompson Blvd Building D, Suite 2015 E Saint Louis IL 62201-1129 | |
| (618) 482-6959 | |
| (618) 482-8311 |
| Full Name | Southern Illinois University |
|---|---|
| Speciality | Clinic/center |
| Location | 601 James R Thompson Blvd, E Saint Louis, Illinois |
| Authorized Official Name and Position | Kim Wenona White (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6184826959 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois University 601 James R Thompson Blvd Building D, Suite 2015 E Saint Louis IL 62201-1129 Ph: (618) 482-6959 | Southern Illinois University 601 James R Thompson Blvd Building D, Suite 2015 E Saint Louis IL 62201-1129 Ph: (618) 482-6959 |
| NPI Number | 1306273776 |
|---|---|
| Provider Enumeration Date | 10/01/2013 |
| Last Update Date | 10/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306273776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |