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General NPI Number Information
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NPI Number | 1932441946
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Entity Type | Organization
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Legal Business Name | THE BOARD OF TRUSTEES OF SIU GOVERNING SIUE
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | STUDENT SUCCESS CTR RM 0222 CAMPUS BOX 1055
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City | EDWARDSVILLE
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State | IL
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Zip | 62026-1055
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Country | US
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Telephone | 618-650-2850
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Fax | 618-650-5839
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Provider Business Mailing Address
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Address Line | STUDENT SUCCESS CTR RM 0222 CAMPUS BOX 1055
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City | EDWARDSVILLE
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State | IL
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Zip | 62026-1055
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Country | US
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Telephone | 618-650-2850
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Fax | 618-650-5839
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Authorized Official
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Title or Position | DIRECTOR, HEALTH SERVICE
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Name | RIANE B GREENWALT
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Credential |
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Telephone | 618-650-2852
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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 |
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License Number State |
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