Provider Demographics
NPI:1518140326
Name:SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PURCHASING
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:UFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-650-3255
Mailing Address - Street 1:601 JAMES R THOMPSON BLVD
Mailing Address - Street 2:BUILDING D 2015
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-1129
Mailing Address - Country:US
Mailing Address - Phone:618-482-6959
Mailing Address - Fax:618-482-8311
Practice Address - Street 1:601 JAMES R THOMPSON BLVD
Practice Address - Street 2:BUILDING D 2015
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-1129
Practice Address - Country:US
Practice Address - Phone:618-482-6959
Practice Address - Fax:618-482-8311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN ILLINOIS UNIVERSITY EDWARDSVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-14
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service