1023151461 NPI number — SOUTHERN ILLINOIS UNIVERSITY

Table of content: DR. JULIE TWOMOON NMD, DIPL AC (NPI 1720145675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023151461 NPI number — SOUTHERN ILLINOIS UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN ILLINOIS UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023151461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
374 EAST GRAND AVENUE
Provider Second Line Business Mailing Address:
MAIL CODE 674D
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-453-3311
Provider Business Mailing Address Fax Number:
618-453-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 EAST GRAND AVENUE
Provider Second Line Business Practice Location Address:
MAIL CODE 674D
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-453-3311
Provider Business Practice Location Address Fax Number:
618-453-4449
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRESLEY
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR SIU STUDENT HEALTH CENTER
Authorized Official Telephone Number:
618-453-4485

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)