Provider Demographics
NPI:1902063027
Name:THE COLLEGE OF ST SCHOLASTICA
Entity Type:Organization
Organization Name:THE COLLEGE OF ST SCHOLASTICA
Other - Org Name:STUDENT HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR SCHWB
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-723-6017
Mailing Address - Street 1:1200 KENWOOD AVE
Mailing Address - Street 2:STUDENT HEALTH SERVICE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4199
Mailing Address - Country:US
Mailing Address - Phone:218-723-6282
Mailing Address - Fax:218-723-5953
Practice Address - Street 1:1200 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4199
Practice Address - Country:US
Practice Address - Phone:218-723-6282
Practice Address - Fax:218-723-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1113747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherFEDERAL TAX ID