STATE OF DELAWARE NPI 1750459160

NPI Information

STATE OF DELAWARE is a student health clinic center in Dover, DE. STATE OF DELAWARE NPI is 1750459160. The provider is registered as an organization entity type.
The provider Other Name Is Indian River Wellness Center.

The provider's business location address is:

417 FEDERAL ST
DOVER, DE
ZIP 19901-635
Phone: (302) 744-4849
Fax: (302) 739-6627

The provider's authorized official is Herman Ellis .
The authorized official title is Medical Director and has the following contact phone number (302) 744-4700.

The enumeration date for this NPI number is 12/1/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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