Provider Demographics
NPI:1992855225
Name:ITHACA COLLEGE STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:ITHACA COLLEGE STUDENT HEALTH SERVICES
Other - Org Name:HAMMOND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. HEALTH CENTER OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-274-3205
Mailing Address - Street 1:953 DANBY RD
Mailing Address - Street 2:HAMMOND HEALTH, ITHACA COLLEGE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-7000
Mailing Address - Country:US
Mailing Address - Phone:607-274-3177
Mailing Address - Fax:607-274-1844
Practice Address - Street 1:953 DANBY RD
Practice Address - Street 2:HAMMOND HEALTH, ITHACA COLLEGE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-7000
Practice Address - Country:US
Practice Address - Phone:607-274-3177
Practice Address - Fax:607-274-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health