Provider Demographics
NPI:1639290893
Name:STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JAWAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-221-4386
Mailing Address - Street 1:1 GOOCH DR.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23187-8795
Mailing Address - Country:US
Mailing Address - Phone:757-221-4386
Mailing Address - Fax:757-221-1245
Practice Address - Street 1:ONE GOOCH DRIVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23187-8795
Practice Address - Country:US
Practice Address - Phone:757-221-4386
Practice Address - Fax:757-221-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023275261QH0100X
VA0101023274261QH0100X
VA0024164693261QH0100X
VA0110002232261QH0100X
VA0001070729261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service