Healthcare Provider Details

I. General information

NPI: 1457332736
Provider Name (Legal Business Name): WESLEYAN UNIVERSITY - DAVISON HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 HIGH ST
MIDDLETOWN CT
06459-3232
US

IV. Provider business mailing address

327 HIGH ST
MIDDLETOWN CT
06459-3232
US

V. Phone/Fax

Practice location:
  • Phone: 860-685-2470
  • Fax: 860-685-2471
Mailing address:
  • Phone: 860-685-2470
  • Fax: 860-685-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number0016
License Number StateCT

VIII. Authorized Official

Name: JOHN MEERTS
Title or Position: INTER. V.P. FOR FINANCE AND TREASUR
Credential:
Phone: 860-685-2607