Healthcare Provider Details

I. General information

NPI: 1346239696
Provider Name (Legal Business Name): PURDUE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

IV. Provider business mailing address

601 STADIUM MALL DR
WEST LAFAYETTE IN
47907-2052
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-1700
  • Fax: 765-496-1227
Mailing address:
  • Phone: 765-494-1700
  • Fax: 765-496-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JOAN M VAUGHAN
Title or Position: DIRECTOR HIPAA PRIVACY COMPLIANCE
Credential:
Phone: 765-496-1927