Healthcare Provider Details

I. General information

NPI: 1336200294
Provider Name (Legal Business Name): NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF STEWART AND BRELAND DR NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
LAS CRUCES NM
88003-8001
US

IV. Provider business mailing address

PO BOX 30001 MSC 3529 NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
LAS CRUCES NM
88003-8001
US

V. Phone/Fax

Practice location:
  • Phone: 505-646-1512
  • Fax: 505-646-2692
Mailing address:
  • Phone: 505-646-1512
  • Fax: 505-646-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number6370NEWMEXICODEPTOFH
License Number StateNM

VIII. Authorized Official

Name: LORI MCKEE
Title or Position: DIRECTOR
Credential: MBA
Phone: 505-646-1512