STEPHEN F. AUSTIN STATE UNIVERSITY (NPI# 1477807121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477807121 |
| Entity Type | Organization |
| Organization Name | STEPHEN F. AUSTIN STATE UNIVERSITY |
| Other Organization Name | STEPHEN F. AUSTIN STATE UNIVERSITY SPORTS MEDICINE |
| Practice Address |
712 Hayter 13010 Sfa Station Nacogdoches TX 75962-3940 |
| Mailing Address |
712 Hayter Po Box 13010 Sfa Station Nacogdoches TX 75962-3940 |
| Practice Telephone | 9364683506 |
| Practice Fax Number | 9364684580 |
| Mailing Telephone | 9364683506 |
| Mailing Fax Number | 9364684580 |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2014-02-27 |
| Authorized Official Name | DR. BAKER PATILLO (PRESIDENT) |
| Authorized Official Telephone | 9364682201 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS1000X |
Clinic/Center Specialization: Student Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Stephen F. Austin State University Sports Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114361250 | Stephen F. Austin State University | Clinic/Center | 2106 Raquet St, Nacogdoches, TX 75962-0001 | 2013-04-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | STEPHEN F AUSTIN STATE UNIVERSITY | 1936 North St, Nacogdoches, TX 75965-3940 |
| Street Address |
712 HAYTER 13010 SFA STATION |
| City | NACOGDOCHES |
| State | TX |
| Zip Code | 75962-3940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073643300 | Linda Stark Bobo | Specialist/Technologist | 1936 N Street, Hpe Complex, Rm 204, Sfasfu, Nacogdoches, TX 75962 | 2007-03-06 |
| 1346895620 | Daniel Anthony Latourelle | Specialist/Technologist | 712 Hayter Street, Nacogdoches, TX 75962-0001 | 2019-08-05 |
| 1730638164 | Marie Collins Custead | Dietitian, Registered | Sfa Athletic Fieldhouse 712 Hayter St, Nacogdoches, TX 75962-0001 | 2016-09-27 |
| 1275081051 | Kira Rubin | Specialist/Technologist | Sfa Athletic Fieldhouse, 712 Hayter St, Nacogdoches, TX 75962-0001 | 2016-09-21 |
| 1790113736 | Jennifer Boynton | Dietitian, Registered | 712 Hayter 13010 Sfa Sta, Nacogdoches, TX 75962-0001 | 2013-10-30 |
| 1114361250 | Stephen F. Austin State University | Clinic/Center | 2106 Raquet St, Nacogdoches, TX 75962-0001 | 2013-04-19 |
| 1336411818 | Alberta Nichols | Specialist/Technologist | 113 Hayter St, Nacogdoches, TX 75962-0001 | 2012-01-31 |
| 1881719821 | Raymond Lynn Eastman | Psychologist | 209 Blount St, Nacogdoches, TX 75962-0001 | 2007-03-20 |
| 1225185531 | John Miller | Family Medicine | 13058-sfa Statiion, Nacogdoches, TX 75962-0001 | 2007-01-05 |
| 1093876005 | Renal Care Group Nacogdoches, LLP | Clinic/Center | 3226 University Dr, 100, Nacogdoches, TX 75962-0001 | 2006-12-13 |
| Find all providers in zip 75962 | ||||
| Taxonomy Code | 261QS1000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Student Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114361250 | Stephen F. Austin State University | Clinic/Center | 2106 Raquet St, Nacogdoches, TX 75962-0001 | 2013-04-19 |
| 1265501076 | Stephen F. Austin State Univ. Health Service | Clinic/Center | 2106 Raguet St N, Box 13058, Nacogdoches, TX 75962-0001 | 2006-11-07 |
| 1063727048 | Stephen F Austin State University Sports Medicine | Clinic/Center | 1936 North St, Sfa Sports Medicine Clinic, Nacogdoches, TX 75965-3940 | 2010-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801447669 | Wayne Williams | Clinic/Center | 244 Flightline, Spring Branch, TX 78070-6241 | 2019-09-24 |
| 1528454675 | University of Houston Health Center | Clinic/Center | 100 Uh Health Ctr, Houston, TX 77204-3019 | 2015-04-15 |
| 1669716205 | Campbell University Inc | Clinic/Center | 5050 Spring Valley Rd, Dallas, TX 75244-3995 | 2012-11-20 |
| 1811283294 | Aledo Isd | Clinic/Center | 1008 Bailey Ranch Rd, Aledo, TX 76008-3110 | 2011-06-23 |
| 1316231228 | Desoto Isd | Clinic/Center | 600 Eagle Dr, Desoto, TX 75115-6006 | 2011-06-08 |
| 1952695538 | The University of Texas At El Paso | Clinic/Center | 550 W University Ave, Union Complex East #100, El Paso, TX 79968-8900 | 2011-06-01 |
| 1649579533 | Owens Franklin Health Center, Prairie View A&m University | Clinic/Center | Ofhc, Reda Bland Evans @ O. J. Baker Street, Prairie View A&m University, Prairie View, TX 77446 | 2011-03-18 |
| 1346551959 | University of North Texas | Clinic/Center | 1800 Chestnut St, Denton, TX 76201 | 2010-06-29 |
| 1427296946 | St Marys University | Clinic/Center | One Camino Santa Maria, San Antonio, TX 78228-8545 | 2009-01-22 |
| 1740491497 | University Health Center Phcy | Clinic/Center | 1528 Avenue J, Huntsville, TX 77340-5227 | 2007-05-24 |
| Find all providers with the same taxonomy | ||||
| City | NACOGDOCHES |
| Zip Code | 75962 |
Please comment or provide details below to improve the information on STEPHEN F. AUSTIN STATE UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.