Provider Demographics
NPI:1942276092
Name:BRIGHAM YOUNG UNIVERSITY
Entity Type:Organization
Organization Name:BRIGHAM YOUNG UNIVERSITY
Other - Org Name:BYU STUDENT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-422-7443
Mailing Address - Street 1:1750 N WYMOUNT TERRACE DR
Mailing Address - Street 2:2300 SHC
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-4800
Mailing Address - Country:US
Mailing Address - Phone:801-422-2771
Mailing Address - Fax:801-422-0764
Practice Address - Street 1:1750 N WYMOUNT TERRACE DR
Practice Address - Street 2:2300
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-4800
Practice Address - Country:US
Practice Address - Phone:801-422-2771
Practice Address - Fax:801-422-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service