| Board Of Trustees Of Southern Illinois University | |
|
601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 | |
| (618) 482-6959 | |
| (618) 482-8311 |
| Full Name | Board Of Trustees Of Southern Illinois University |
|---|---|
| Speciality | Clinic/Center |
| Location | 601 James R Thompson Blvd, East Saint Louis, Illinois |
| Authorized Official Name and Position | Myjal Garner (DIRECTOR) |
| Authorized Official Contact | 6184826959 |
| 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 601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 Ph: (618) 482-6959 | Board Of Trustees Of Southern Illinois University 601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 Ph: (618) 482-6959 |
| NPI Number | 1104230168 |
|---|---|
| Provider Enumeration Date | 06/18/2014 |
| Last Update Date | 06/07/2026 |
| Medicare PECOS PAC ID | 3173749157 |
|---|---|
| Medicare Enrollment ID | O20140728002465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104230168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Southern Illinois Healthcare Foundation, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2001 State St, East Saint Louis, IL 62205 Phone: 618-271-0207 Fax: 618-271-9617 | |
Osh-il Physicians Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2420 State St, East Saint Louis, IL 62205 Phone: 618-318-8809 Fax: 618-615-4205 | |
Southern Illinois Healthcare Foundation, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6010 Bond Ave, East Saint Louis, IL 62207 Phone: 618-337-8153 Fax: 618-337-8905 | |
Southern Illinois Regional Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1736 Kingshighway, East Saint Louis, IL 62204 Phone: 618-874-3120 Fax: 618-215-4048 | |
Roadside Medical, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 699 State Route 203, Suite 1, East Saint Louis, IL 62201 Phone: 941-225-2520 Fax: 888-860-8609 | |
Kenneth Hall Regional Hospital, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 129 N 8th St, East Saint Louis, IL 62201 Phone: 618-482-7044 Fax: 618-482-7018 |