Provider Demographics
NPI:1033511787
Name:ALFRED UNIVERSITY
Entity Type:Organization
Organization Name:ALFRED UNIVERSITY
Other - Org Name:ALFRED UNIVERSITY SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD ATHLETICS TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLBUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-871-2916
Mailing Address - Street 1:5050 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3995
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:1 SAXON DR
Practice Address - Street 2:MCLANE GYMNASIUM
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1205
Practice Address - Country:US
Practice Address - Phone:607-871-2891
Practice Address - Fax:607-871-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty