SIU CENTER FOR FAMILY MEDICINE-JACKSONVILLE
NPI 1649628009
Clinic/Center - Federally Qualified Health Center (FQHC) in Jacksonville, 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 May 26, 2016CLIA 14D2256221 · Waiver

345 W STATE ST, JACKSONVILLE, IL 62650(217) 245-5111(217) 243-4773 Get Directions Write a Review

NPPES record last updated: May 26, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Siu Center For Family Medicine-jacksonville NPPES

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

SIU CENTER FOR FAMILY MEDICINE-JACKSONVILLE (NPI 1649628009) is a healthcare organization registered as a federally qualified health center (fqhc) in Jacksonville, Illinois and active in the NPI registry since May 2016. The organization holds a CLIA Waiver certificate valid through March 21, 2028 and lists Iris Wesley, Ceo, as its authorized official.

NPPES Registry Identity

NPI1649628009

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY

Location Address345 W STATE STJacksonville, IL 62650-1879

Mailing Address520 N 4th St, Po Box 19671Springfield, IL 62702-5238 · (217) 545-8000 · Fax (217) 747-1351

Phone(217) 245-5111

Fax(217) 243-4773

Organization SubpartNo

Authorized OfficialIris WesleyCeo · (217) 545-8000

Enumeration DateMay 26, 2016

✔ NPI 1649628009 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

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

Taxonomy Code261QF0400X

345 W STATE ST, Jacksonville, IL 62650

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Other Names 1

Doing Business AsSiu Center For Family Medicine-jacksonville

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 14D2256221

Siu Center For Family Medicine - Jacksonville · Jacksonville, IL

Active · expires Mar 21, 2028

CLIA Number14D2256221

Laboratory TypeFederally Qualified Health Center

Certificate Effective DateMarch 22, 2026

Certificate Expiration DateMarch 21, 2028

Laboratory DirectorMichal Dynda

Laboratory Phone(217) 245-5111

Laboratory LocationSiu Center For Family Medicine - Jacksonville425 E State St, Jacksonville, IL 62650

CLIA data matches this NPI record on: Name Phone

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

Other Providers at the Same Location NPPES

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

DONNA MARIE LEISCHNER CERTIFIED NURSE PRAC

Nurse Practitioner

345 W STATE ST
JACKSONVILLE, IL 62650

Morgan County (217) 245-5111

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 1649628009. It was assigned to this organization in the NPPES registry on May 26, 2016. The provider is doing business as Siu Center For Family Medicine-Jacksonville.

Where is Board Of Trustees Of Southern Illinois University located?

Board Of Trustees Of Southern Illinois University is located at 345 W State St, Jacksonville, IL 62650. The listed phone number is (217) 245-5111.

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.

Does Board Of Trustees Of Southern Illinois University hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2256221) is associated with this NPI, valid through March 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Board Of Trustees Of Southern Illinois University was last updated on May 26, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.