| Organization Name: | GRAMBLING STATE UNIVERSITY |
| NPI Number: | 1043648173 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICE OUTLEY (DIRECTOR OF STUDENT HEALTH SERVICES) |
| Mailing Address: | 403 Main St Grambling |
| State: | LA US |
| Postal Code: | 712452715 |
| Phone Number: | 3182742351 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2013 |
| NPI Last Update Date: | 10/29/2013 |
| 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: | |