Provider Demographics
NPI:1073733390
Name:DAVIDSON COLLEGE STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:DAVIDSON COLLEGE STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-894-2300
Mailing Address - Street 1:514 N. MAIN ST
Mailing Address - Street 2:CAMPUS BOX 7188
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28035
Mailing Address - Country:US
Mailing Address - Phone:704-894-2300
Mailing Address - Fax:704-894-2615
Practice Address - Street 1:514 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-894-2300
Practice Address - Fax:704-894-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-AD 1494 335261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health