SIU CENTER FOR FAMILY MEDICINE
NPI 1497002182
Clinic/Center - Federally Qualified Health Center (FQHC) in Springfield, 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 August 13, 2012CLIA 14D2115368 · Waiver

520 N 4TH ST, SPRINGFIELD, IL 62702(217) 545-8000(217) 757-8161 Get Directions Write a Review

NPPES record last updated: January 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Siu Center For Family Medicine NPPES

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

SIU CENTER FOR FAMILY MEDICINE (NPI 1497002182) is a healthcare organization registered as a federally qualified health center (fqhc) in Springfield, Illinois and active in the NPI registry since August 2012. The organization holds a CLIA Waiver certificate valid through July 5, 2028 and lists Iris Wesley, Ceo, as its authorized official.

NPPES Registry Identity

NPI1497002182

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address520 N 4TH STSpringfield, IL 62702-5238

Mailing AddressPo Box 19639Springfield, IL 62794-9639 · (217) 545-8000 · Fax (217) 747-1351

Phone(217) 545-8000

Fax(217) 757-8161

Organization SubpartYes

Authorized OfficialIris WesleyCeo · (217) 545-8000

Enumeration DateAugust 13, 2012

Last NPPES UpdateJanuary 9, 2025

NPPES CertifiedJanuary 9, 2025

✔ NPI 1497002182 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

520 N 4TH ST, Springfield, IL 62702

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Other Names 1

Doing Business AsSiu Center For Family Medicine

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2115368

Siu Center For Family Medicine-Mbh · Springfield, IL

Active · expires Jul 5, 2028

CLIA Number14D2115368

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateJuly 6, 2026

Certificate Expiration DateJuly 5, 2028

Laboratory DirectorMichal Dynda MD

Laboratory Phone(217) 757-8942

Laboratory LocationSiu Center For Family Medicine-MbhMental Health Centers Of Central Illinois 710 N Eighth St, Springfield, IL 62702

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

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. AMANDA B HENSON LCSW

Social Worker (Clinical)