Provider Demographics
NPI:1265672174
Name:ELON UNIVERSITY
Entity Type:Organization
Organization Name:ELON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STORSVED
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:336-278-6800
Mailing Address - Street 1:2500 CAMPUS BOX
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244
Mailing Address - Country:US
Mailing Address - Phone:336-278-6800
Mailing Address - Fax:336-278-6767
Practice Address - Street 1:2500 CAMPUS BOX
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244
Practice Address - Country:US
Practice Address - Phone:336-278-6800
Practice Address - Fax:336-278-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care