Healthcare Provider Details

I. General information

NPI: 1437580107
Provider Name (Legal Business Name): NORTH CAROLINA CENTRAL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CAFETERIA DRIVE
DURHAM NC
27707
US

IV. Provider business mailing address

1801 FAYETTEVILLE STREET STUDENT HEALTH BUILDING
DURHAM NC
27707
US

V. Phone/Fax

Practice location:
  • Phone: 919-530-6317
  • Fax: 919-530-7969
Mailing address:
  • Phone: 919-530-7336
  • Fax: 919-530-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TYRONE LITTLE
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 919-530-5485