NPIMap

Organization Active NPI

Stephen F. Austin State University

Doing business as SFASU Student Health

  • Student Health Clinic/Center
  • Nacogdoches, TX
National Provider Identifier
1114361250
Registry record updated Apr 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
STEPHEN F. AUSTIN STATE UNIVERSITY
Doing business as
SFASU Student Health
Practice address
2106 Raquet St
Nacogdoches, TX 75962-0001
Phone
(936) 468-4006
NPI assigned
Apr 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2013

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

Authorized official

Name
Dr. Baker Patillo, PHD
Title
President
Phone
(936) 468-4580

Specialties & licenses 1

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

Addresses

Primary practice location

2106 Raquet St
Nacogdoches, TX 75962-0001

Mailing address

2106 Raquet St
PO Box 13058 Sfa Station
Nacogdoches, TX 75962-0001
Phone (936) 468-4006

Other names 1

  • SFASU Student Health Doing business as

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.

Locations

2106 Raquet St
Nacogdoches, TX 75962
Phone (936) 468-4006

13058 2106 Raguet Box
Nacogdoches, TX 75962

Practitioners & affiliated clinicians

Practitioners 1

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": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366329600000",
    "number": "1114361250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 RAQUET ST",
            "address_2": "PO BOX 13058 SFA STATION",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759620001",
            "telephone_number": "936-468-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 RAQUET ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759620001",
            "telephone_number": "936-468-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F. AUSTIN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2013-04-19",
        "status": "A",
        "authorized_official_last_name": "PATILLO",
        "authorized_official_first_name": "BAKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-468-4580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SFASU Student Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 19, 2013; 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.