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General NPI Number Information
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NPI Number | 1568345445
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Entity Type | Organization
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Legal Business Name | CLEMSON UNIVERSITY
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 200 BOOKER DR
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City | WALHALLA
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State | SC
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Zip | 29691-2278
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Country | US
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Telephone | 864-656-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 101 EDWARDS HALL
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City | CLEMSON
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State | SC
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Zip | 29634-0001
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Country | US
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Telephone | 864-656-3076
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Fax |
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Authorized Official
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Title or Position | DIRECTOR CLEMSON RURAL HEALTH
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Name | RONALD W GIMBEL
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Credential |
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Telephone | 864-656-3076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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