Provider Demographics
NPI:1174680318
Name:CEDARVILLE UNIVERSITY
Entity Type:Organization
Organization Name:CEDARVILLE UNIVERSITY
Other - Org Name:UNIVERSITY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, BC
Authorized Official - Phone:937-766-7862
Mailing Address - Street 1:251 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-8501
Mailing Address - Country:US
Mailing Address - Phone:937-766-7862
Mailing Address - Fax:937-766-7865
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8501
Practice Address - Country:US
Practice Address - Phone:937-766-7862
Practice Address - Fax:937-766-7865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDARVILLE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health