MEDICARE: WASHINGTON AND LEE UNIVERSITY

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1942540208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON AND LEE UNIVERSITY

Provider Business Mailing Address
First Line	:	204 W WASHINGTON ST
Second Line	:	STUDENT HEALTH CENTER/DAVIS RESIDENCE HALL
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2116
Country	:	US
Telephone Number	:	540-458-8401
Fax Number	:	540-458-8404

Provider Business Practice Location Address
First Line	:	204 W WASHINGTON ST
Second Line	:	STUDENT HEALTH CENTER/DAVIS RESIDENCE HALL
City	:	LEXINGTON
State	:	VA
Zip	:	24450-2116
Country	:	US
Telephone Number	:	540-458-8401
Fax Number	:	540-458-8404

Authorized Official
Title or Position	:	VP/FINANCE AND TREASURER
Name	:	STEVEN G. MCALLISTER
Credential	:
Telephone Number	:	540-458-8942

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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1972514412 — JANE TRACY HORTON MD
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1326387689 — MARIA CHRISTINA BARONGAN PHD
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Practice Location Address:

204 W WASHINGTON ST , EARLY-FIELDING BUILDING
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1275941866 — ROBERT PHILLIPS MS, ATC
Practice Location Address:

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1487355798 — CLARK SIMCOE RDN
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Directions to “WASHINGTON AND LEE UNIVERSITY ” Practice Location

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