1902985484 NPI number — CLEMSON UNIVERSITY

Table of content: (NPI 1902985484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902985484 NPI number — CLEMSON UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEMSON UNIVERSITY
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:
1902985484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-626-9660
Provider Business Mailing Address Fax Number:
833-953-0588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1521 PERIMETER RD
Provider Second Line Business Practice Location Address:
FIRE STATION
Provider Business Practice Location Address City Name:
CLEMSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29634-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-656-2242
Provider Business Practice Location Address Fax Number:
864-656-3555
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUNYEA
Authorized Official First Name:
AARON
Authorized Official Middle Name:
R
Authorized Official Title or Position:
INTERIM FIRE CHIEF
Authorized Official Telephone Number:
864-643-7163

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  153 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00778268 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: AB0186 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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