Provider Demographics
NPI:1003153701
Name:JAMES MADISON UNIVERSITY HEALTH CENTER
Entity Type:Organization
Organization Name:JAMES MADISON UNIVERSITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:GUERTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-568-6113
Mailing Address - Street 1:724 S MASON STREET MSC 7901
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807-1015
Mailing Address - Country:US
Mailing Address - Phone:540-568-6178
Mailing Address - Fax:540-568-7803
Practice Address - Street 1:724 SOUTH MASON STREET MSC 7901
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-1015
Practice Address - Country:US
Practice Address - Phone:540-568-6178
Practice Address - Fax:540-568-6176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES MADISON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023181005OtherNPI
1134322852OtherNPI
1790873792OtherNPI
1770580987OtherNPI
1053315630OtherNPI
1114992500OtherNPI