Provider Demographics
NPI:1285848358
Name:UNIVERSITY OF NOTRE DAME HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF NOTRE DAME HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-631-8286
Mailing Address - Street 1:107 SAINT LIAM HALL
Mailing Address - Street 2:
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556-5612
Mailing Address - Country:US
Mailing Address - Phone:574-631-6574
Mailing Address - Fax:574-631-3874
Practice Address - Street 1:107 SAINT LIAM HALL
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556-5612
Practice Address - Country:US
Practice Address - Phone:574-631-6574
Practice Address - Fax:574-631-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005298A261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health