Provider Demographics
NPI:1538576939
Name:STUDENT HEALTH SERVICE
Entity type:Organization
Organization Name:STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-777-3868
Mailing Address - Street 1:2891 2ND AVE N STOP 9038
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9038
Mailing Address - Country:US
Mailing Address - Phone:701-777-3868
Mailing Address - Fax:701-777-4835
Practice Address - Street 1:2891 2ND AVE N STOP 9038
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9038
Practice Address - Country:US
Practice Address - Phone:701-777-3868
Practice Address - Fax:701-777-4835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health