Provider Demographics
NPI:1588987333
Name:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICE
Entity type:Organization
Organization Name:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:CROUCH
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:252-737-2821
Mailing Address - Street 1:1000 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-2502
Mailing Address - Country:US
Mailing Address - Phone:252-737-2821
Mailing Address - Fax:252-328-4007
Practice Address - Street 1:1000 E 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2502
Practice Address - Country:US
Practice Address - Phone:252-737-2821
Practice Address - Fax:252-328-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health