Provider Demographics
NPI:1679917710
Name:PURDUE UNIVERSITY
Entity Type:Organization
Organization Name:PURDUE UNIVERSITY
Other - Org Name:IPFW CENTER FOR HEALTH LIVING: CAMPUS CLINIC AND WELLNES PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FINKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:260-481-6564
Mailing Address - Street 1:2101 E COLISEUM BLVD
Mailing Address - Street 2:WALB UNION 234
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1445
Mailing Address - Country:US
Mailing Address - Phone:260-481-5748
Mailing Address - Fax:260-481-5752
Practice Address - Street 1:2101 E COLISEUM BLVD
Practice Address - Street 2:WALB UNION 234
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1445
Practice Address - Country:US
Practice Address - Phone:260-481-5748
Practice Address - Fax:260-481-5752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURDUE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center