Provider Demographics
NPI:1538347034
Name:BYU IDAHO STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:BYU IDAHO STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTHCARE CENTER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:208-496-3434
Mailing Address - Street 1:100 SHC
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83460-2010
Mailing Address - Country:US
Mailing Address - Phone:208-496-1300
Mailing Address - Fax:208-496-1306
Practice Address - Street 1:100 SHC
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83460-2010
Practice Address - Country:US
Practice Address - Phone:208-496-1300
Practice Address - Fax:208-496-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center