NPIMap

Organization Active NPI

State of Delaware

  • Student Health Clinic/Center
  • Dover, DE
National Provider Identifier
1699843003
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
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

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X NU Primary

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 1

IdentifierTypeStateIssuer
1000013819MedicaidDE

Other names 1

  • Christiana Wellness Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Psychiatry Delaware Sta131 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.

View all 24

NPI Registry JSON

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": "1699843003",
    "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000013819",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christiana Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dover, DE

Sources for this page

  • 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.