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General NPI Number Information
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NPI Number | 1881819886
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Entity Type | Organization
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Legal Business Name | STUDENT HEALTH SERVICE UNIVERSITY OF ST. THOMAS
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2115 SUMMIT AVE MAILBOX #5056
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City | SAINT PAUL
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State | MN
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Zip | 55105-1048
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Country | US
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Telephone | 651-962-6750
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Fax | 651-962-6751
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Provider Business Mailing Address
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Address Line | 2115 SUMMIT AVE MAILBOX #5056
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City | SAINT PAUL
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State | MN
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Zip | 55105-1048
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Country | US
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Telephone | 651-962-6750
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Fax | 651-962-6751
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Authorized Official
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Title or Position | DIRECTOR STUDENT HEALTH SERVICE
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Name | MS. MADONNA K MC DERMOTT
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Credential | MS, MPA
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Telephone | 651-962-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | MN32783
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License Number State | MN
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