| Board Of Trustees Of Southern Illinois University | |
|
102 W Kenwood Ave Decatur IL 62526-4368 | |
| (217) 872-3800 | |
| (217) 872-0849 |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/Center |
| Location | 102 W Kenwood Ave, Decatur, Illinois |
| Authorized Official Name and Position | Iris Wesley (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2175457876 |
| 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) 872-3800 | Board Of Trustees Of Southern Illinois University 102 W Kenwood Ave Decatur IL 62526-4368 Ph: (217) 872-3800 |
| NPI Number | 1407376338 |
|---|---|
| Provider Enumeration Date | 06/21/2017 |
| Last Update Date | 01/09/2025 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20170717002084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407376338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
Veteran's Administration Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3035 E Mound Rd, Decatur, IL 62526 Phone: 217-875-2670 Fax: 217-875-2689 | |
Anthony O Amiewalan Md, Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2965 N Main St Ste A, Decatur, IL 62526 Phone: 217-422-0560 Fax: 217-422-0872 | |
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Planned Parenthood Of Illinois Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3021 N Oakland Ave, Decatur, IL 62526 Phone: 217-877-6474 Fax: 217-877-9452 | |
Gowdar & Gowdar Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 741 W Pershing Rd, Decatur, IL 62526 Phone: 217-876-7200 Fax: 217-876-7233 | |
Millikin University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1184 W Main St, Decatur, IL 62522 Phone: 972-367-4845 | |
Decatur Memorial Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2300 N Edward St, Gsbll, Decatur, IL 62526 Phone: 217-876-2868 Fax: 217-876-2874 |