Provider Demographics
NPI:1851387286
Name:APPALACHIAN STATE UNIVERSITY
Entity Type:Organization
Organization Name:APPALACHIAN STATE UNIVERSITY
Other - Org Name:COMMUNICATION DISORDERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERPROFESSIONAL CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:828-262-8657
Mailing Address - Street 1:400 UNIVERSITY HALL DRIVE
Mailing Address - Street 2:ROOM 120
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2041
Mailing Address - Country:US
Mailing Address - Phone:828-262-2185
Mailing Address - Fax:828-262-6766
Practice Address - Street 1:400 UNIVERSITY HALL DRIVE
Practice Address - Street 2:ROOM 120
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2041
Practice Address - Country:US
Practice Address - Phone:828-262-2185
Practice Address - Fax:828-262-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201123Medicaid
NC0101POtherBLUE CROSS BLUE SHIELD
NC2699758Medicare PIN