NPIMap

Organization Active NPI

Stephen F Austin State University Sports Medicine

  • Student Health Clinic/Center
  • Nacogdoches, TX
National Provider Identifier
1063727048
Registry record updated Aug 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE
Practice address
1936 North St
Sfa Sports Medicine Clinic
Nacogdoches, TX 75965-3940
Phone
(936) 468-4550
Fax
(936) 468-4052
NPI assigned
Aug 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2010

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

Authorized official

Name
Sandy Miller, ATC
Title
Asst Ad for Sports Medicine
Phone
(936) 468-4550

Specialties & licenses 1

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

Addresses

Primary practice location

1936 North St
Sfa Sports Medicine Clinic
Nacogdoches, TX 75965-3940

Mailing address

1936 North St
Sfa Sports Medicine Clinic
Nacogdoches, TX 75965-3940
Phone (936) 468-4550

National Provider Directory

National Provider Directory
Tax ID family
Sfasu Student Health5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281657600000",
    "number": "1063727048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 NORTH ST",
            "address_2": "SFA SPORTS MEDICINE CLINIC",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759653940",
            "telephone_number": "936-468-4550",
            "fax_number": "936-468-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 NORTH ST",
            "address_2": "SFA SPORTS MEDICINE CLINIC",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759653940",
            "telephone_number": "936-468-4550",
            "fax_number": "936-468-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2010-08-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "ASST AD FOR SPORTS MEDICINE",
        "authorized_official_telephone_number": "936-468-4550",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2010; 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.