Board of Trustees of Southern Illinois University
Board of Trustees of Southern Illinois University is a Multi-Specialty Clinic/Center in East Saint Louis, Illinois. Registered with an NPI since 2014.
- In the registry since
- 2014
- Specialties on file
- 2
Practice location Address checks out
601 James R Thompson Blvd Bldg D Ste 2015East Saint Louis, IL 62201-1129
Phone: (618) 482-6959
Fax: (618) 482-8311
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Nurse Practitioner (primary) | Taxonomy 363L00000X |
|---|---|
| Multi-Specialty Clinic/Center | Taxonomy 261QM1300X |
Record details
| NPI number | 1104230168 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Myjal Garner — Director · (618) 482-6959 |
| Other names | Southern Illinois University Edwardsville |
| NPI enumerated | June 18, 2014 |
| Last updated in NPPES | July 15, 2026 |
| Certification date | July 15, 2026 |
| Mailing address | 601 James R Thompson Blvd, Building D, Suite 2015, East Saint Louis, IL 62201-1129 |