Provider Demographics
NPI:1326360579
Name:NORTH CAROLINA CENTRAL UNIVERSITY
Entity Type:Organization
Organization Name:NORTH CAROLINA CENTRAL UNIVERSITY
Other - Org Name:STUDENT HEALTH AND COUNSELING SERVICE LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF STUDENT HELATH
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:919-530-7908
Mailing Address - Street 1:1801 FAYETTEVILLE ST
Mailing Address - Street 2:PO BOX 19491
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3129
Mailing Address - Country:US
Mailing Address - Phone:919-530-6317
Mailing Address - Fax:919-530-6650
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:OLD HEALTH BUILDING
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3129
Practice Address - Country:US
Practice Address - Phone:919-530-6317
Practice Address - Fax:919-530-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D0688623291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAIH0085120OtherPEARCE AND PEARCE