NPIMap

Organization Active NPI

Stephen F. Austin State University

Doing business as Stephen F. Austin State University Sports Medicine

  • Student Health Clinic/Center
  • Nacogdoches, TX
National Provider Identifier
1477807121
Registry record updated Feb 27, 2014
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
Stephen F. Austin State University Sports Medicine
Practice address
712 Hayter
13010 Sfa Station
Nacogdoches, TX 75962-3940
Phone
(936) 468-3506
Fax
(936) 468-4580
NPI assigned
Nov 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2014

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) 468-2201

Specialties & licenses 1

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

Addresses

Primary practice location

712 Hayter
13010 Sfa Station
Nacogdoches, TX 75962-3940

Mailing address

712 Hayter
PO Box 13010 Sfa Station
Nacogdoches, TX 75962-3940
Phone (936) 468-3506

Other names 1

  • Stephen F. Austin State University Sports Medicine 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

712 Hayter
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": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393459200000",
    "number": "1477807121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 HAYTER",
            "address_2": "PO BOX 13010 SFA STATION",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759623940",
            "telephone_number": "936-468-3506",
            "fax_number": "936-468-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 HAYTER",
            "address_2": "13010 SFA STATION",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759623940",
            "telephone_number": "936-468-3506",
            "fax_number": "936-468-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN F. AUSTIN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2014-02-27",
        "status": "A",
        "authorized_official_last_name": "PATILLO",
        "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": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephen F. Austin State University Sports Medicine",
            "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 Feb 27, 2014; 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.