1881819886 NPI number — STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS

Table of content: SCOTT MICHAEL KOLLMEYER PHARMD (NPI 1386424232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881819886 NPI number — STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS
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:
1881819886
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:
2115 SUMMIT AVE
Provider Second Line Business Mailing Address:
MAILBOX #5056
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55105-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-962-6750
Provider Business Mailing Address Fax Number:
651-962-6751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 SUMMIT AVE
Provider Second Line Business Practice Location Address:
MAILBOX #5056
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55105-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-962-6750
Provider Business Practice Location Address Fax Number:
651-962-6751
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MC DERMOTT
Authorized Official First Name:
MADONNA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR STUDENT HEALTH SERVICE
Authorized Official Telephone Number:
651-962-6750

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  MN32783 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184740664 . This is a "NPI MADONNA MCDERMOTT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1669443222 . This is a "NPI DR. THOMAS THUL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1215999081 . This is a "NPI DR. MARILEE VOTEL-KVA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1225156227 . This is a "NPI GAIL CONZEMIUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1114057510 . This is a "NPI KATE BOOTH, NP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".