MEDICARE: SWARTHMORE COLLEGE STUDENT HEALTH SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	VP006640B	PA

General Provider Information

NPI Number	:	1578750428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWARTHMORE COLLEGE STUDENT HEALTH SERVICE

Provider Business Mailing Address
First Line	:	500 COLLEGE AVE
Second Line	:	SWARTHMORE COLLEGE HEALTH SERVICES
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8058
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 COLLEGE AVE
Second Line	:	SWARTHMORE COLLEGE HEALTH SERVICES
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	610-328-8058
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, STUDENT HEALTH SERVICES
Name	:	MS. BETH ANN KOTARSKI
Credential	:	CRNP
Telephone Number	:	610-328-8058

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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