Provider Demographics
NPI:1699707687
Name:BOWLING GREEN STATE UNIVERSITY
Entity type:Organization
Organization Name:BOWLING GREEN STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:EGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-372-1318
Mailing Address - Street 1:PO BOX 5199
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5199
Mailing Address - Country:US
Mailing Address - Phone:325-437-8300
Mailing Address - Fax:325-437-8399
Practice Address - Street 1:RIDGE STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0147
Practice Address - Country:US
Practice Address - Phone:419-372-2271
Practice Address - Fax:419-372-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0614222Medicaid
OHB09355222Medicare ID - Type Unspecified