Provider Demographics
NPI:1528363066
Name:COLUMBUS STATE UNIVERSITY
Entity Type:Organization
Organization Name:COLUMBUS STATE UNIVERSITY
Other - Org Name:CSU STUDENT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, HEALTH SVC
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-507-8260
Mailing Address - Street 1:PO BOX 671205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1205
Mailing Address - Country:US
Mailing Address - Phone:866-890-6390
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:4225 UNIVERSITY AVE
Practice Address - Street 2:TUCKER HALL
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5679
Practice Address - Country:US
Practice Address - Phone:706-507-8620
Practice Address - Fax:706-568-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty