Provider Demographics
NPI:1093024838
Name:EASTERN MICHIGAN UNIVERSITY
Entity Type:Organization
Organization Name:EASTERN MICHIGAN UNIVERSITY
Other - Org Name:UNIVERSITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-487-1107
Mailing Address - Street 1:200 SNOW HEALTH CENTER
Mailing Address - Street 2:EASTERN MICHIGAN UNIVERSITY
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2207
Mailing Address - Country:US
Mailing Address - Phone:734-487-1122
Mailing Address - Fax:734-487-2342
Practice Address - Street 1:200 SNOW HEALTH CENTER
Practice Address - Street 2:EASTERN MICHIGAN UNIVERSITY
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2207
Practice Address - Country:US
Practice Address - Phone:734-487-1122
Practice Address - Fax:734-487-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service