State of Delaware
Organization Active NPI Student Health Clinic/Center · Dover, DE
NPI 1104984525 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1104984525
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Student Health Clinic/Center 261QS1000X
- Legal business name
- STATE OF DELAWARE
- Practice address
- 417 Federal St
Dover, DE 19901-3635 - Phone
- (302) 744-4849
- Fax
- (302) 739-6627
- NPI assigned
- Dec 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Herman Ellis, MD
- Title
- Medical Director
- Phone
- (302) 744-4700
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- DVH Dental Suite
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student Health Clinic/Center | 261QS1000X | Yes |
Addresses
Primary practice location
417 Federal St
Dover, DE 19901-3635
Mailing address
417 Federal St
Dover, DE 19901-3635
Phone (302) 744-4849
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1000013808 | Medicaid | DE |
Other names
- Wilmington Wellness Center
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All providers in Dover, DE · Student Health Clinic/Center in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.