Provider Demographics
NPI:1518101161
Name:TUSKEGEE UNIVERSITY STUDENT CLINIC
Entity Type:Organization
Organization Name:TUSKEGEE UNIVERSITY STUDENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-212-5602
Mailing Address - Street 1:203 W LEE ST
Mailing Address - Street 2:TUSKEGEE UNIVERSITY CAMPUS
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1719
Mailing Address - Country:US
Mailing Address - Phone:334-727-7050
Mailing Address - Fax:
Practice Address - Street 1:203 W LEE ST
Practice Address - Street 2:TUSKEGEE UNIVERSITY CAMPUS
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1719
Practice Address - Country:US
Practice Address - Phone:334-727-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)