Provider Demographics
NPI:1992864821
Name:THE COLLEGE OF ST. SCHOLASTICA
Entity Type:Organization
Organization Name:THE COLLEGE OF ST. SCHOLASTICA
Other - Org Name:STUDENT HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRCTOR SCHWB
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-723-6017
Mailing Address - Street 1:CSS 1200 KENWOOD AVENUE
Mailing Address - Street 2:STUDENT HEALTH SERVICE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-723-6282
Mailing Address - Fax:218-723-5953
Practice Address - Street 1:CSS 1200 KENWOOD AVENUE
Practice Address - Street 2:STUDENT HEALTH SERVICE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-723-6282
Practice Address - Fax:218-723-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherFEDERAL TAX I.D.