1. Home
  2. Directory
  3. Illinois
  4. Lincoln
  5. Clinic Center
  6. NPI Profile

SIU CENTER FOR FAMILY MEDICINE - LINCOLN
NPI 1972049641
Clinic/Center - Federally Qualified Health Center (FQHC) in Lincoln, IL

Active since January 18, 2017CLIA 14D2124063 · Waiver
109 3RD ST, LINCOLN, IL 62656(217) 735-2317(217) 732-6943 Get Directions Write a Review

NPPES record last updated: January 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 9, 2025, Jan 18, 2017 (2 updates tracked since 2017).

About Siu Center For Family Medicine - Lincoln NPPES

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

SIU CENTER FOR FAMILY MEDICINE - LINCOLN (NPI 1972049641) is a healthcare organization registered as a federally qualified health center (fqhc) in Lincoln, Illinois and active in the NPI registry since January 2017. The organization holds a CLIA Waiver certificate valid through January 8, 2027 and lists Iris Wesley, Ceo, as its authorized official.

NPPES Registry Identity

NPI1972049641
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameBOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Location Address109 3RD STLincoln, IL 62656-2604
Mailing AddressPo Box 19639Springfield, IL 62794-9639 · (217) 545-8000
Phone(217) 735-2317
Fax(217) 732-6943
Organization SubpartYes
Authorized OfficialIris WesleyCeo · (217) 545-7876
Enumeration DateJanuary 18, 2017
Last NPPES UpdateJanuary 9, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 9, 2025
✔ NPI 1972049641 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
109 3RD ST, Lincoln, IL 62656
Open in Google Maps ↗

Other Names 1

Doing Business AsSiu Center For Family Medicine - Lincoln

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 14D2124063

Siu Center For Family Medicine-Lincoln · Lincoln, IL
Active · expires Jan 8, 2027
CLIA Number14D2124063
Laboratory TypeState Univ Lab
Certificate Effective DateJanuary 9, 2025
Certificate Expiration DateJanuary 8, 2027
Laboratory DirectorMichal Dynda MD
Laboratory Phone(217) 757-8942
Laboratory LocationSiu Center For Family Medicine-LincolnLogan County Health Dept 109 3rd St, Lincoln, IL 62656
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 9

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

COUNTY OF LOGAN
Public Health or Welfare
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
JESSICA ANN DEMARCO PA-C
Physician Assistant
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
MRS. MARY ANN SOUTHERLAN RDH, PHDH
Dental Hygienist
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
JARED LUCAS ROLAND BHS,MPAS,PA-C
Physician Assistant
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
DANIELLE HERNAN
Community Health Worker
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
COUNTY OF LOGAN
Public Health or Welfare
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
CASSANDRA DAHM RDH
Dental Hygienist
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317
DR. SHARON ELIZABETH MOLITORIS DDS
Dentist
109 3RD ST
LINCOLN, IL 62656
Logan County (217) 735-2317

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 1972049641. It was assigned to this organization in the NPPES registry on January 18, 2017. The provider is doing business as Siu Center For Family Medicine - Lincoln.

Where is Board Of Trustees Of Southern Illinois University located?

Board Of Trustees Of Southern Illinois University is located at 109 3rd St, Lincoln, IL 62656. The listed phone number is (217) 735-2317.

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 14D2124063) is associated with this NPI, valid through January 8, 2027. 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 January 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.