Healthcare Provider Details

I. General information

NPI: 1083056287
Provider Name (Legal Business Name): ECSU STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 WEEKSVILLE RD
ELIZABETH CITY NC
27909-7977
US

IV. Provider business mailing address

1704 WEEKSVILLE RD
ELIZABETH CITY NC
27909-7977
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-3267
  • Fax: 252-335-3269
Mailing address:
  • Phone: 252-335-3267
  • Fax: 252-335-3269

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: REGINA MCCOY-DAVIS
Title or Position: DIRECTOR
Credential: RN, MSN
Phone: 252-335-3267