1497906507 NPI number — ESU 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 1497906507 NPI number — ESU STUDENT HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESU 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:
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:
1497906507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 COMMERCIAL ST
Provider Second Line Business Mailing Address:
CAMPUS BOX 4008
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66801-5057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-341-5222
Provider Business Mailing Address Fax Number:
620-341-5045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
CAMPUS BOX 4008
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-5057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-341-5222
Provider Business Practice Location Address Fax Number:
620-341-5045
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCDANIEL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
ASSISTANT DIRECTOR
Authorized Official Telephone Number:
620-341-5222

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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