Provider Demographics
NPI:1508911330
Name:GUSTAVUS ADOLPHUS COLLEGE
Entity Type:Organization
Organization Name:GUSTAVUS ADOLPHUS COLLEGE
Other - Org Name:GUSTAVUS ADOLPHUS COLLEGE HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-933-7630
Mailing Address - Street 1:800 W COLLEGE AVE
Mailing Address - Street 2:HEALTH SERVICE
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1485
Mailing Address - Country:US
Mailing Address - Phone:507-933-8000
Mailing Address - Fax:507-933-6074
Practice Address - Street 1:800 W COLLEGE AVE
Practice Address - Street 2:HEALTH SERVICE
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1485
Practice Address - Country:US
Practice Address - Phone:507-933-8000
Practice Address - Fax:507-933-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty