Provider Demographics
NPI:1831532050
Name:TROY UNITERSITY STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:TROY UNITERSITY STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIRICO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-670-3452
Mailing Address - Street 1:321 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36082-0001
Mailing Address - Country:US
Mailing Address - Phone:334-670-3452
Mailing Address - Fax:334-670-3853
Practice Address - Street 1:321 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:SUITE 125
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36082-0001
Practice Address - Country:US
Practice Address - Phone:334-670-3452
Practice Address - Fax:334-670-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service