NPIMap

Organization Active NPI

Sam Houston State University

  • Multi-Specialty Clinic/Center
  • Conroe, TX
National Provider Identifier
1942850565
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SAM HOUSTON STATE UNIVERSITY
Practice address
1169 Grand Central Pkwy
Conroe, TX 77304-3185
Phone
(936) 525-3600
Fax
(936) 525-3624
NPI assigned
Sep 16, 2019
Last updated
Sep 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SAM HOUSTON STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Authorized official

Name
Amanda Withers
Title
Cfo and Sr VP for Operations
Phone
(936) 294-2686

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X
Family Medicine Physician 207Q00000X
Sports Medicine (Family Medicine) Physician 207QS0010X
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X
Pediatric Hematology & Oncology Physician 2080P0207X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1169 Grand Central Pkwy
Conroe, TX 77304-3185

Mailing address

1169 Grand Central Pkwy
Conroe, TX 77304-3185
Phone (936) 525-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200317002361 TX Part B Supplier - Clinic/Group Practice 8123451135 Receives reassigned benefits from 14 practitioners
Practice locations: Conroe, TX

National Provider Directory

National Provider Directory
Tax ID family
Sam Houston State University Diagnostic Laboratory for Human Health5 organizations share this tax ID, including this one
Part of
Sam Houston State University Diagnostic Laboratory for Human Health

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1169 Grand Central Pkwy
Conroe, TX 77304
Phone (936) 525-3600

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1942850565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 GRAND CENTRAL PKWY",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043185",
            "telephone_number": "936-525-3600",
            "fax_number": "936-525-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 GRAND CENTRAL PKWY",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043185",
            "telephone_number": "936-525-3600",
            "fax_number": "936-525-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM HOUSTON STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAM HOUSTON STATE UNIVERSITY",
        "enumeration_date": "2019-09-16",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A",
        "authorized_official_last_name": "WITHERS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CFO AND SR VP FOR OPERATIONS",
        "authorized_official_telephone_number": "936-294-2686"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.