Provider Demographics
NPI:1881054302
Name:EASTERN MENNONITE UNIVERSITY
Entity type:Organization
Organization Name:EASTERN MENNONITE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KNISS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:540-432-4302
Mailing Address - Street 1:1200 PARK RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-2404
Mailing Address - Country:US
Mailing Address - Phone:540-432-4308
Mailing Address - Fax:540-432-4099
Practice Address - Street 1:1200 PARK RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2404
Practice Address - Country:US
Practice Address - Phone:540-432-4308
Practice Address - Fax:540-432-4099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN MENNONITE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518219666Medicaid