Provider Demographics
NPI:1881819886
Name:STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS
Entity Type:Organization
Organization Name:STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MC DERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPA
Authorized Official - Phone:651-962-6750
Mailing Address - Street 1:2115 SUMMIT AVE
Mailing Address - Street 2:MAILBOX #5056
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1048
Mailing Address - Country:US
Mailing Address - Phone:651-962-6750
Mailing Address - Fax:651-962-6751
Practice Address - Street 1:2115 SUMMIT AVE
Practice Address - Street 2:MAILBOX #5056
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1048
Practice Address - Country:US
Practice Address - Phone:651-962-6750
Practice Address - Fax:651-962-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN32783261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1184740664OtherNPI MADONNA MCDERMOTT
MN1669443222OtherNPI DR. THOMAS THUL
MN1215999081OtherNPI DR. MARILEE VOTEL-KVA
MN1225156227OtherNPI GAIL CONZEMIUS
MN1114057510OtherNPI KATE BOOTH, NP