Provider Demographics
NPI:1407038615
Name:THE JAMES A TAYLOR STUDENT HEALTH SERVICES SPORTS MEDICINE DEPARTMENT
Entity Type:Organization
Organization Name:THE JAMES A TAYLOR STUDENT HEALTH SERVICES SPORTS MEDICINE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR SPORTS MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-966-3655
Mailing Address - Street 1:THE JAMES A TAYLOR STUDENT HEALTH SERVICES CB# 7470
Mailing Address - Street 2:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7470
Mailing Address - Country:US
Mailing Address - Phone:919-966-3655
Mailing Address - Fax:919-966-9779
Practice Address - Street 1:THE JAMES A TAYLOR STUDENT HEALTH SERVICES CB# 7470
Practice Address - Street 2:THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-3655
Practice Address - Fax:919-966-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN 159674261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health