Healthcare Provider Details

I. General information

NPI: 1497906507
Provider Name (Legal Business Name): ESU STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COMMERCIAL ST CAMPUS BOX 4008
EMPORIA KS
66801-5057
US

IV. Provider business mailing address

1200 COMMERCIAL ST CAMPUS BOX 4008
EMPORIA KS
66801-5057
US

V. Phone/Fax

Practice location:
  • Phone: 620-341-5222
  • Fax: 620-341-5045
Mailing address:
  • Phone: 620-341-5222
  • Fax: 620-341-5045

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. MARY E. MCDANIEL
Title or Position: ASSISTANT DIRECTOR
Credential: RNC
Phone: 620-341-5222