NPI |
1891815908 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
APPALACHIAN STATE UNIVERSITY |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
MARY S. SHOOK STUDENT HEALTH SERVICE |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
5 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
614 HOWARD STREET |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Second Line Business Practice Location Address |
STUDENT HEALTH SERVICE |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Business Practice Location Address City Name |
BOONE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NC |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
286082070 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Telephone Number |
8282623100 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Fax Number |
8282626958 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Enumeration Date |
3/30/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
9/1/2023 |
|
Authorized Official Last Name |
DULL |
|
Authorized Official First Name |
MATTHEW |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Authorized Official Middle Name |
C |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Authorized Official Title or Position |
ASSISTANT VICE CHANCELLOR FOR FINAN |
|
Authorized Official Telephone Number |
8282622060 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Taxonomy Code 1 |
261QS1000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
NPI Certification Date |
9/1/2023 |
|