Provider Demographics
NPI:1730157272
Name:BALDWIN WALLACE UNIVERSITY
Entity type:Organization
Organization Name:BALDWIN WALLACE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE AND ADMIN.
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-826-8101
Mailing Address - Street 1:275 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2088
Mailing Address - Country:US
Mailing Address - Phone:440-826-2178
Mailing Address - Fax:440-826-3382
Practice Address - Street 1:207 BEECH ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2088
Practice Address - Country:US
Practice Address - Phone:440-826-2178
Practice Address - Fax:440-826-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health