Provider Demographics
NPI:1720120637
Name:NORTH CAROLINA A&T STATE UNIVERSITY
Entity type:Organization
Organization Name:NORTH CAROLINA A&T STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM STUDENT HEALTH CENTER DIREC
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTYE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-334-7880
Mailing Address - Street 1:1601 E MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27411
Mailing Address - Country:US
Mailing Address - Phone:336-334-7880
Mailing Address - Fax:336-256-2613
Practice Address - Street 1:112 N. BENBOW ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411
Practice Address - Country:US
Practice Address - Phone:336-334-7880
Practice Address - Fax:336-256-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service