Provider Demographics
NPI:1497906507
Name:ESU STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:ESU STUDENT HEALTH SERVICES
Other - Org Name:DEPARTMENT OF STUDENT WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:620-341-5222
Mailing Address - Street 1:1200 COMMERCIAL ST
Mailing Address - Street 2:CAMPUS BOX 4008
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5057
Mailing Address - Country:US
Mailing Address - Phone:620-341-5222
Mailing Address - Fax:620-341-5045
Practice Address - Street 1:1200 COMMERCIAL ST
Practice Address - Street 2:CAMPUS BOX 4008
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5057
Practice Address - Country:US
Practice Address - Phone:620-341-5222
Practice Address - Fax:620-341-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health