St. Alyssa Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ST. ALYSSA MEDICAL CENTER

Practice address

2805 North St Ste E
Nacogdoches, TX 75965-2800

Phone

(936) 205-3171

Fax

(936) 205-3174

NPI assigned

Jan 31, 2017

Last updated

Nov 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael L. Bishop, CLINIC DIRECTORNPI 1235783283

Title

Clinic Director

Phone

(936) 645-1586

Specialties & licenses 2

Addresses

Locations

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.

• Michael L. Bishop, GRADUATING MEDICAL S

  • Student in an Organized Health Care Education/Training Program
  • Nacodoches, TX
  • NPI 1235783283
  NPD Authorized official

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1710425541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635312",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75963",
            "telephone_number": "936-645-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 NORTH ST STE E",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652800",
            "telephone_number": "936-205-3171",
            "fax_number": "936-205-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ALYSSA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-31",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "936-645-1586",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CLINIC DIRECTOR"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodrigo William Sotillo, MD
• Southern Physician Group Management LLC
• Mark Ephrom Sowell, DPM
• Brooke Spann, APRN
• Arthur L Speck, M.D.
• Andrew Staehling, ATC, LAT
• Stallings Court SCC LLC (Stallings Court Nursing & Rehab)
• Pebbles Antionette Steadham
• Stephen F Austin State University Sports Medicine
• Stephen F. Austin State Univ. Health Service

• Family Medicine Physician in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.