MEDICARE: BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1598412447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 19639
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9639
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E STATE ST., STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2125
Country	:	US
Telephone Number	:	217-408-1195
Fax Number	:	217-408-1231

Authorized Official
Title or Position	:	CEO
Name	:	IRIS WESLEY
Credential	:
Telephone Number	:	217-545-8000

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	01/09/2025

Similar Medicare Providers

1710645544 — ANDREA DIANE MOORE FNP-BC
Practice Location Address:

425 E STATE ST
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-408-1195
Practice Fax:

1316974595 — COUNTY OF MORGAN HEALTH DEPT
Practice Location Address:

425 E STATE STREET
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-245-5111
Practice Fax: 217-243-4773

1740777093 — TAMARA BRECKON
Practice Location Address:

425 E STATE ST STE 100
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-408-1195
Practice Fax: 217-408-1231

1679105308 — SARAH B JARMAN FNP
Practice Location Address:

425 E STATE ST STE 100
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-408-1195
Practice Fax: 217-408-1231

1043801574 — MEGAN VANT MA, LCPC, CADC
Practice Location Address:

425 E STATE ST
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-408-1195
Practice Fax: 217-408-1231

1124611256 — SHERRI LINDGREN
Practice Location Address:

425 E STATE ST STE 100
JACKSONVILLE, IL
62650-2125

Practice Phone: 217-545-8000
Practice Fax:

Directions to “BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.