NPIMap

Organization Active NPI

Stephen F. Austin State University Cole Audiology Lab

  • Audiologist
  • Nacogdoches, TX
National Provider Identifier
1366604183
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
80104 Issued in TX
Legal business name
STEPHEN F. AUSTIN STATE UNIVERSITY COLE AUDIOLOGY LAB
Practice address
2100 N Raguet
No. 205
Nacogdoches, TX 75961
Phone
(936) 468-1252
Fax
(936) 468-7096
NPI assigned
Jul 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Dr. Baker Pattillo, PH.D.
Title
President
Phone
(936) 468-2201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X 80104 TX Primary

Addresses

Primary practice location

2100 N Raguet
No. 205
Nacogdoches, TX 75961

Mailing address

1936 N Street Austin 315
PO Box 6145, Sfa Station
Nacogdoches, TX 75962-0001
Phone (936) 468-2201

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

1936 N St Austin 315
Nacogdoches, TX 75962

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1366604183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 N STREET AUSTIN 315",
            "address_2": "PO BOX 6145, SFA STATION",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759620001",
            "telephone_number": "936-468-2201",
            "fax_number": "936-468-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N RAGUET",
            "address_2": "NO. 205",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75961",
            "telephone_number": "936-468-1252",
            "fax_number": "936-468-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F. AUSTIN STATE UNIVERSITY COLE AUDIOLOGY LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "PATTILLO",
        "authorized_official_first_name": "BAKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-468-2201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "TX",
            "license": "80104",
            "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 Jul 2, 2008; 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.