Provider Demographics
NPI:1063040095
Name:ELMIRA COLLEGE
Entity Type:Organization
Organization Name:ELMIRA COLLEGE
Other - Org Name:CLARKE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:607-735-1750
Mailing Address - Street 1:1 PARK PL
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2085
Mailing Address - Country:US
Mailing Address - Phone:607-735-1750
Mailing Address - Fax:607-735-1198
Practice Address - Street 1:1 PARK PL
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2085
Practice Address - Country:US
Practice Address - Phone:607-735-1750
Practice Address - Fax:607-735-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health