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General NPI Number Information
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NPI Number | 1104030790
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Entity Type | Organization
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Legal Business Name | EASTERN ILLINOIS UNIVERSITY HEALTH SERVICE
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 LINCOLN AVE EASTERN ILLINOIS UNIVERSITY
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City | CHARLESTON
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State | IL
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Zip | 61920-3011
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Country | US
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Telephone | 217-581-3015
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Fax | 217-581-3899
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Provider Business Mailing Address
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Address Line | 600 LINCOLN AVE EASTERN ILLINOIS UNIVERSITY
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City | CHARLESTON
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State | IL
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Zip | 61920-3011
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Country | US
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Telephone | 217-581-3015
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Fax | 217-581-3899
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SHEILA D BAKER
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Credential | MD
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Telephone | 217-581-3015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | E9988478107
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License Number State | IL
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