Organization Name: | STATE OF DELAWARE |
NPI Number: | 1003984410 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HERMAN ELLIS (MEDICAL DIRECTOR) |
Mailing Address: | 417 Federal St Dover |
State: | DE US |
Postal Code: | 199013635 |
Phone Number: | 3027444849 |
Fax Number: | 3027396627 |
NPI Enumeration Date: | 12/01/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Student Health |
Taxonomy Definition: |