Provider Demographics
NPI:1437361326
Name:WVU STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:WVU STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANVARD-FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-293-2311
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:PO BOX 9247
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9247
Mailing Address - Country:US
Mailing Address - Phone:304-293-2311
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:ROBERT C. BYRD HEALTH SCIENCES CENTER
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9247
Practice Address - Country:US
Practice Address - Phone:304-293-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16084261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health