State of Delaware

Primary specialty

Student Health Clinic/CenterTaxonomy code 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 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Herman Ellis, MD

Title

Medical Director

Phone

(302) 744-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dover High Wellness Center Other name

Tax ID family

Dept HLTH Soc Serv Psyc131 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Delaware Division of Substance Abuse and Mental Health

  dba Sussex Bridge Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Georgetown, DE
  • NPI 1285345306
  NPD tax ID
• Delaware Early Childhood Center

  • Local Education Agency (LEA)
  • Harrington, DE
  • NPI 1376687244
  NPD tax ID
• First State Montessori

  • Local Education Agency (LEA)
  • Wilmington, DE
  • NPI 1295126407
  NPD tax ID
• Gateway Lab School

  • Local Education Agency (LEA)
  • Wilmington, DE
  • NPI 1275965832
  NPD tax ID
• Kent/Sussex Detoxification Center

  • Substance Abuse Rehabilitation Facility
  • Ellendale, DE
  • NPI 1184738601
  NPD tax ID
• Las Americas Aspira Academy

  • Local Education Agency (LEA)
  • Newark, DE
  • NPI 1174955736
  NPD tax ID
• State of Delaware

  • Student Health Clinic/Center
  • Dover, DE
  • NPI 1174691588
  NPD tax ID
• State of Delaware

  dba Marion T. Academy Charter School

  • Local Education Agency (LEA)
  • Wilmington, DE
  • NPI 1194869065
  NPD tax ID
• State of Delaware

  • State or Local Public Health Clinic/Center
  • Dover, DE
  • NPI 1194890269
  NPD tax ID
• State of Delaware

  • Health Service Psychologist
  • Dover, DE
  • NPI 1215009097
  NPD tax ID
• State of Delaware

  dba Bureau of Oral Health and Dental Services

  • Dental Clinic/Center
  • Dover, DE
  • NPI 1225100092
  NPD tax ID
• State of Delaware

  • Dental Clinic/Center
  • Dover, DE
  • NPI 1245302017
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285702696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 FEDERAL ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013635",
            "telephone_number": "302-744-4849",
            "fax_number": "302-739-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 FEDERAL ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013635",
            "telephone_number": "302-744-4849",
            "fax_number": "302-739-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF DELAWARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "HERMAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "302-744-4700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000013832",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dover High Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• State of Delaware
• State of Delaware
• State of Delaware (Bureau of Oral Health and Dental Services)
• State of Delaware
• State of Delaware
• State of Delaware
• State of Delaware
• State of Delaware (Bureau of Oral Health and Dental Services)
• State of Delaware
• State of Delaware

• Student Health Clinic/Center in Dover, DE
• Providers in Dover, DE by specialty
• Student Health Clinic/Center in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.