Organization Name: | PURDUE UNIVERSITY |
NPI Number: | 1598111791 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIEL J LAYMAN (EXECUTIVE DIRECTOR) |
Mailing Address: | 128 W Market St Wolcott |
State: | IN US |
Postal Code: | 479958130 |
Phone Number: | 2197472067 |
Fax Number: | 2197472068 |
NPI Enumeration Date: | 05/06/2016 |
NPI Last Update Date: | 05/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |