Provider Demographics
NPI:1083881452
Name:BEMIDJI STATE UNIVERSITY
Entity Type:Organization
Organization Name:BEMIDJI STATE UNIVERSITY
Other - Org Name:STUDENT HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSSON-CAPES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:218-755-2053
Mailing Address - Street 1:1500 BIRCHMONT DR NE # 30
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2600
Mailing Address - Country:US
Mailing Address - Phone:218-755-2053
Mailing Address - Fax:
Practice Address - Street 1:1500 BIRCHMONT DR NE # 30
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2600
Practice Address - Country:US
Practice Address - Phone:218-755-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center