SIU CENTER FOR FAMILY MEDICINE - DECATUR
NPI 1407376338
Clinic/Center - Federally Qualified Health Center (FQHC) in Decatur, IL

Q: What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since June 21, 2017

102 W KENWOOD AVE, DECATUR, IL 62526(217) 872-3800(217) 872-0849 Get Directions Write a Review

NPPES record last updated: January 9, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 9, 2025, Jun 21, 2017 (2 updates tracked since 2017).

On this page

About Siu Center For Family Medicine - Decatur NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIU CENTER FOR FAMILY MEDICINE - DECATUR (NPI 1407376338) is a healthcare organization registered as a federally qualified health center (fqhc) in Decatur, Illinois and active in the NPI registry since June 2017. The organization lists Iris Wesley, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1407376338

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address102 W KENWOOD AVEDecatur, IL 62526-4368

Mailing AddressPo Box 19639Springfield, IL 62794-9639 · (217) 872-3800 · Fax (217) 872-0849

Phone(217) 872-3800

Fax(217) 872-0849

Organization SubpartYes

Authorized OfficialIris WesleyChief Executive Officer · (217) 545-7876

Enumeration DateJune 21, 2017

Last NPPES UpdateJanuary 9, 20252 updates tracked since enumeration

NPPES CertifiedJanuary 9, 2025

✔ NPI 1407376338 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X

102 W KENWOOD AVE, Decatur, IL 62526

Open in Google Maps ↗

Other Names 1

Doing Business AsSiu Center For Family Medicine - Decatur

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. VIRGINIA ANN KERWIN R.D. ,CDE, LDN

Dietitian, Registered

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 545-8000

DRS GRAHAM & GRAHAM LTD

Podiatrist (Foot & Ankle Surgery)

102 W KENWOOD AVE, SUITE 150
DECATUR, IL 62526

Macon County (217) 875-3668

BROOKLYNN JUNE ALDRIDGE

Community Health Worker

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 972-5857

MISS ROBYN PLOESSL DPT

Physical Therapist

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 876-2690

MICHAEL STEPHEN KOCH MS, ATC

Specialist/Technologist (Athletic Trainer)

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 876-6820

TAMMY KAY MUNCH PA-C

Physician Assistant

102 W KENWOOD AVE, SUITE 110
DECATUR, IL 62526

Macon County (217) 876-6880

KYLIE VANDYKE

Social Worker (Clinical)

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 520-1047

MR. JEFFREY BRUCE ROUNDS M.S., A.T.C., L.A.T

Specialist/Technologist (Athletic Trainer)

102 W KENWOOD AVE
DECATUR, IL 62526

Macon County (217) 876-6820

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Board Of Trustees Of Southern Illinois University's NPI number?

The NPI number for Board Of Trustees Of Southern Illinois University is 1407376338. It was assigned to this organization in the NPPES registry on June 21, 2017. The provider is doing business as Siu Center For Family Medicine - Decatur.

Where is Board Of Trustees Of Southern Illinois University located?

Board Of Trustees Of Southern Illinois University is located at 102 W Kenwood Ave, Decatur, IL 62526. The listed phone number is (217) 872-3800.

What is Board Of Trustees Of Southern Illinois University's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

When was this NPI record last updated?

The NPPES record for Board Of Trustees Of Southern Illinois University was last updated on January 9, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.