Provider Demographics
NPI:1336200294
Name:NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-646-1512
Mailing Address - Street 1:PO BOX 30001 MSC 3529
Mailing Address - Street 2:NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:505-646-1512
Mailing Address - Fax:505-646-2692
Practice Address - Street 1:CORNER OF STEWART AND BRELAND DR
Practice Address - Street 2:NEW MEXICO STATE UNIVERSITY STUDENT HEALTH CENTER
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-8001
Practice Address - Country:US
Practice Address - Phone:505-646-1512
Practice Address - Fax:505-646-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6370NEWMEXICODEPTOFH261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health