NPIMap

Organization Active NPI

Illinois State University

  • Health Service Clinic/Center
  • Normal, IL
National Provider Identifier
1336216027
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
ILLINOIS STATE UNIVERSITY
Doing business as
ISU Student Health Service
Practice address
College and University
Suite 2540
Normal, IL 61790-2540
Phone
(309) 438-8258
Fax
(309) 438-3689
NPI assigned
Nov 29, 2006
Organization subpart
Yes
Parent organization
ILLINOIS STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Mr. James Kellogg Jr.
Title
Associate Director
Phone
(309) 438-8258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

College and University
Suite 2540
Normal, IL 61790-2540

Mailing address

College and University
Suite 2540
Normal, IL 61790-2540
Phone (309) 438-8258

Other names 1

  • ISU Student Health Service Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Illinois State University4 organizations share this tax ID, including this one
Part of
Illinois State University

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

College And University
Normal, IL 61790
Phone (309) 438-8258

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1336216027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COLLEGE AND UNIVERSITY",
            "address_2": "SUITE 2540",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617902540",
            "telephone_number": "309-438-8258",
            "fax_number": "309-438-3689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COLLEGE AND UNIVERSITY",
            "address_2": "SUITE 2540",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617902540",
            "telephone_number": "309-438-8258",
            "fax_number": "309-438-3689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ILLINOIS STATE UNIVERSITY",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "309-438-8258",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISU Student Health Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.