1124138243 NPI number — NC STATE UNIVERSITY STUDENT HEALTH

Table of content: MACKENZIE LOU KIRCHHOFF PT, DPT (NPI 1598557845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124138243 NPI number — NC STATE UNIVERSITY STUDENT HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NC STATE UNIVERSITY STUDENT HEALTH
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:
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:
1124138243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7304 CAMPUS
Provider Second Line Business Mailing Address:
2815 CATES AVE
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27695-7304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-513-3276
Provider Business Mailing Address Fax Number:
919-513-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7304 CAMPUS
Provider Second Line Business Practice Location Address:
2815 CATES AVE
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27695-7304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-513-3276
Provider Business Practice Location Address Fax Number:
919-513-0440
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
MARIANNE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
919-513-3276

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  3222 , 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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