Provider Demographics
NPI:1659469617
Name:THE UNIVERSITY OF NORTH CAROLINA - CHAPEL HILL
Entity Type:Organization
Organization Name:THE UNIVERSITY OF NORTH CAROLINA - CHAPEL HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRADUATE ASSISTANT ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:773-844-1247
Mailing Address - Street 1:1329 OLD LYSTRA RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9171
Mailing Address - Country:US
Mailing Address - Phone:773-844-1247
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CAMPUS HEALTH SERVICES
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty