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

• Indian River 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 Department of Correction

  • Prison Health Clinic/Center
  • Dover, DE
  • NPI 1801721006
  NPD tax ID
• Delaware Division of Substance Abuse and Mental Health

  dba Hope Center Bridge Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New Castle, DE
  • NPI 1801507751
  NPD tax ID
• Delaware Division of Substance Abuse and Mental Health

  dba New Castle Bridge Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New Castle, DE
  • NPI 1821709361
  NPD tax ID
• Delaware Health and Social Services

  • Ambulatory Family Planning Facility
  • Middletown, DE
  • NPI 1700940459
  NPD tax ID
• Dsu Early College High School

  • Health Service Clinic/Center
  • Dover, DE
  • NPI 1811370158
  NPD tax ID
• State of Delaware

  • State or Local Public Health Clinic/Center
  • Dover, DE
  • NPI 1689753832
  NPD tax ID
• State of Delaware

  • State or Local Public Health Clinic/Center
  • Dover, DE
  • NPI 1699841593
  NPD tax ID
• State of Delaware

  • Student Health Clinic/Center
  • Dover, DE
  • NPI 1699843003
  NPD tax ID
• State of Delaware

  • State or Local Public Health Clinic/Center
  • Dover, DE
  • NPI 1699847491
  NPD tax ID
• State of Delaware

  dba Smyrna School District

  • Local Education Agency (LEA)
  • Smyrna, DE
  • NPI 1730223603
  NPD tax ID
• State of Delaware

  dba Thomas A. Edison Charter School

  • Local Education Agency (LEA)
  • Wilmington, DE
  • NPI 1740324615
  NPD tax ID
• State of Delaware

  dba Christina School District

  • Local Education Agency (LEA)
  • Wilmington, DE
  • NPI 1750425625
  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": "1750459160",
    "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": "1000013825",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian River Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• State of Delaware
• State of Delaware
• State of Delaware
• State of Delaware
• 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

• 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.