Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Board of Trustees of Southern Illinois University

Organization Family Medicine Physician · NPI 1396097960

Board of Trustees of Southern Illinois University is a Family Medicine Physician in Springfield, Illinois. Licensed in Illinois. Registered with an NPI since 2012.

Licensed in
IL
In the registry since
2012
Specialties on file
2

Practice location Address checks out

520 N 4th St
Springfield, IL 62702-5238
Phone: (217) 757-8100
Fax: (217) 747-1351
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X (IL)
Family Medicine Physician Taxonomy 207Q00000X

Record details

NPI number1396097960
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Iris Wesley — Ceo · (217) 545-8000
Other names Siu Center For Family Medicine; Siu Center For Family Medicine
NPI enumeratedOctober 8, 2012
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing addressPo Box 19639, Springfield, IL 62794-9639

Other providers in Springfield