Provider Demographics
NPI:1285843813
Name:OREGON INSTITUTE OF TECHNOLOGY STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:OREGON INSTITUTE OF TECHNOLOGY STUDENT HEALTH CENTER
Other - Org Name:OIT STUDENT HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAN-MORAVEC
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:541-885-1800
Mailing Address - Street 1:3201 CAMPUS DR
Mailing Address - Street 2:SE 115
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-8801
Mailing Address - Country:US
Mailing Address - Phone:541-885-1800
Mailing Address - Fax:541-885-1866
Practice Address - Street 1:3201 CAMPUS DR
Practice Address - Street 2:SE 115
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-8801
Practice Address - Country:US
Practice Address - Phone:541-885-1800
Practice Address - Fax:541-885-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORFP-0000020261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health