Provider Demographics
NPI:1689951022
Name:NORTH CAROLINA STATE UNIVERSITY
Entity Type:Organization
Organization Name:NORTH CAROLINA STATE UNIVERSITY
Other - Org Name:STUDENT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-513-3267
Mailing Address - Street 1:2815 CATES AVE
Mailing Address - Street 2:CB 7304
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-0001
Mailing Address - Country:US
Mailing Address - Phone:919-513-3267
Mailing Address - Fax:919-513-1994
Practice Address - Street 1:2815 CATES AVE
Practice Address - Street 2:CB 7304
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-0001
Practice Address - Country:US
Practice Address - Phone:919-513-3267
Practice Address - Fax:919-513-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health