Provider Demographics
NPI:1891815908
Name:APPALACHIAN STATE UNIVERSITY
Entity Type:Organization
Organization Name:APPALACHIAN STATE UNIVERSITY
Other - Org Name:MARY S. SHOOK STUDENT HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT VICE CHANCELLOR FOR FINAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:DULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-2060
Mailing Address - Street 1:PO BOX 32070
Mailing Address - Street 2:HEALTH SERVICE
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2070
Mailing Address - Country:US
Mailing Address - Phone:828-262-3100
Mailing Address - Fax:828-262-6262
Practice Address - Street 1:614 HOWARD STREET
Practice Address - Street 2:STUDENT HEALTH SERVICE
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2070
Practice Address - Country:US
Practice Address - Phone:828-262-3100
Practice Address - Fax:828-262-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health