Healthcare Provider Details

I. General information

NPI: 1639290893
Provider Name (Legal Business Name): STUDENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GOOCH DRIVE
WILLIAMSBURG VA
23187-8795
US

IV. Provider business mailing address

1 GOOCH DR.
WILLIAMSBURG VA
23187-8795
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-4386
  • Fax: 757-221-1245
Mailing address:
  • Phone: 757-221-4386
  • Fax: 757-221-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0101023275
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0101023274
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0110002232
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0001070729
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0024164693
License Number StateVA

VIII. Authorized Official

Name: MRS. KAREN JAWAN BROWN
Title or Position: HEAD NURSE
Credential:
Phone: 757-221-4386