1417947037 NPI number — WRIGHT STATE UNIVERSITY STUDENT HEALTH SERVICES

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 1417947037 NPI number — WRIGHT STATE UNIVERSITY STUDENT HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT STATE UNIVERSITY STUDENT HEALTH SERVICES
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:
1417947037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3640 COLONEL GLENN HWY
Provider Second Line Business Mailing Address:
051 STUDENT UNION
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-775-2552
Provider Business Mailing Address Fax Number:
937-775-2277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 COLONEL GLENN HWY
Provider Second Line Business Practice Location Address:
051 STUDENT UNION
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-775-2552
Provider Business Practice Location Address Fax Number:
937-775-2277
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
LEATHA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
937-775-2552

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN-238463 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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