Provider Demographics
NPI:1730418641
Name:UNIVERSITY OF NORTH FLORIDA STUDENT MEDICAL SERVICE
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH FLORIDA STUDENT MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-620-2900
Mailing Address - Street 1:1 UNF DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7699
Mailing Address - Country:US
Mailing Address - Phone:904-620-2900
Mailing Address - Fax:904-620-2902
Practice Address - Street 1:1 UNF DRIVE
Practice Address - Street 2:BUILDING 39A ROOM 2098
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7699
Practice Address - Country:US
Practice Address - Phone:904-620-2900
Practice Address - Fax:904-620-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3060732261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER