1285989632 NPI number — APPALACHIAN STATE UNIVERSITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285989632 NPI number — APPALACHIAN STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN STATE 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:
APPALACHIAN STATE ATHLETIC TRAINING AND PHYSICAL THERAPY SERVICES
Provider Other Organization Name Type Code:
3
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:
1285989632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
OWENS FIELD HOUSE
Provider Second Line Business Mailing Address:
135 JACK BRANCH DR
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28608-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-262-6265
Provider Business Mailing Address Fax Number:
828-262-7099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OWENS FIELD HOUSE
Provider Second Line Business Practice Location Address:
135 JACK BRANCH DR
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28608-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-262-6265
Provider Business Practice Location Address Fax Number:
828-262-7099
Provider Enumeration Date:
07/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROBEY
Authorized Official First Name:
JASON
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR OF ATHLETIC TRAINING SERV
Authorized Official Telephone Number:
828-262-6265

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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