NPIMap

Organization Active NPI

Stephen F. Austin State Univ. Health Service

  • Student Health Clinic/Center
  • Nacogdoches, TX
National Provider Identifier
1265501076
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
STEPHEN F. AUSTIN STATE UNIV. HEALTH SERVICE
Practice address
2106 Raguet St N
Box 13058
Nacogdoches, TX 75962-0001
Phone
(936) 468-4008
Fax
(936) 468-1316
NPI assigned
Nov 7, 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
Dr. John Miller, M.D.
Title
Director
Phone
(936) 468-4008

Specialties & licenses 1

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

Addresses

Primary practice location

2106 Raguet St N
Box 13058
Nacogdoches, TX 75962-0001

Mailing address

2106 Raguet St N
Box 13058
Nacogdoches, TX 75962-0001
Phone (936) 468-4008

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0670854Stephen F Austin State University2106 Raguet Street, Nacogdoches, TX 75962Certificate of waiverMay 7, 2027

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 Raguet St N
Nacogdoches, TX 75962
Phone (936) 468-4008

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265501076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 RAGUET ST N",
            "address_2": "BOX 13058",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759620001",
            "telephone_number": "936-468-4008",
            "fax_number": "936-468-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 RAGUET ST N",
            "address_2": "BOX 13058",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759620001",
            "telephone_number": "936-468-4008",
            "fax_number": "936-468-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F. AUSTIN STATE UNIV. HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "936-468-4008",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "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 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.