1013253822 NPI number — STUDENT HEALTH SERVICE, CALIFORNIA STATE UNIVERSITY CHICO

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 1013253822 NPI number — STUDENT HEALTH SERVICE, CALIFORNIA STATE UNIVERSITY CHICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STUDENT HEALTH SERVICE, CALIFORNIA STATE UNIVERSITY CHICO
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:
1013253822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95929-0777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-898-3044
Provider Business Mailing Address Fax Number:
530-898-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 WARNER STR MEDICAL CLINIC FOOR 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95929-0777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-5241
Provider Business Practice Location Address Fax Number:
530-898-4057
Provider Enumeration Date:
12/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
ANEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
530-898-3044

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  CLE 2073 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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