Provider Demographics
NPI:1144629833
Name:NORTH CAROLINA A&T STATE UNIVERSITY
Entity type:Organization
Organization Name:NORTH CAROLINA A&T STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:
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 1:112 N BENBOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27411-0002
Mailing Address - Country:US
Mailing Address - Phone:336-334-7880
Mailing Address - Fax:336-334-7154
Practice Address - Street 1:112 N BENBOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411-0002
Practice Address - Country:US
Practice Address - Phone:336-334-7880
Practice Address - Fax:336-334-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00549261QH0100X
NC9900552261QH0100X
NC9501417261QH0100X
NC24834261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC028UWOtherBCBSNC STUDEN BLUE