# GLENVILLE STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982979548
- **Authorized official:** BRENT WALTERS (HEAD ATHLETIC TRAINER)
- **Authorized official phone:** (304) 462-6223

## Contact information

- **Practice address:** 200 HIGH ST, GLENVILLE, WV 26351-1200
- **Practice address phone:** (304) 462-6223
- **Mailing address:** PO BOX 819020, DALLAS, TX 75381-9020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/15/2012
- **Last updated:** 03/15/2012