STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE (NPI# 1063727048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063727048 |
| Entity Type | Organization |
| Organization Name | STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE |
| Practice Address |
1936 North St Sfa Sports Medicine Clinic Nacogdoches TX 75965-3940 |
| Practice Telephone | 9364684550 |
| Practice Fax Number | 9364684052 |
| Mailing Telephone | 9364684550 |
| Mailing Fax Number | 9364684052 |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2010-08-13 |
| Authorized Official Name | SANDY MILLER (ASST AD FOR SPORTS MEDICINE) |
| Authorized Official Telephone | 9364684550 |
| Authorized Official Credential | ATC |
| 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 |
| Street Address |
1936 NORTH ST SFA SPORTS MEDICINE CLINIC |
| City | NACOGDOCHES |
| State | TX |
| Zip Code | 75965-3940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891000139 | Loree Mccary | Physical Medicine & Rehabilitation | 1936 North St, Sfa Sports Medicine Clinic, Nacogdoches, TX 75965-3940 | 2010-08-11 |
| 1154802841 | Geneva Diosdado | Specialist/Technologist | 1936 North St, Nacogdoches, TX 75965-3940 | 2018-08-22 |
| 1346744802 | Sydney Dailey | Student in an Organized Health Care Education/Training Program | 1936 North St, Nacogdoches, TX 75965-3940 | 2018-03-20 |
| 1811417785 | Alejandro Rodriguez | Specialist/Technologist | 1936 North St, Nacogdoches, TX 75965-3940 | 2017-06-22 |
| 1609320571 | Stephanie Medina | Specialist/Technologist | 1936 North St, Nacogdoches, TX 75965-3940 | 2016-08-09 |
| 1437528379 | Jane Grayson | Specialist/Technologist | 1936 North St, Hpe Building, Room 209, Nacogdoches, TX 75965-3940 | 2015-09-22 |
| 1912381047 | Jeff Smith | Specialist/Technologist | 1936 North St, Sfa Athletics, Nacogdoches, TX 75962-0001 | 2015-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649839135 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3824 N University Drive, Suite 103, Nacogdoches, TX 75965 | 2019-06-10 |
| 1518520493 | Billy Jobe | Pharmacist | 917 East Austin, Nacogdoches, TX 75965 | 2019-04-17 |
| 1295217610 | Sarah Ponder | Registered Nurse | 625 Woodway Lane, Nacogdoches, TX 75965 | 2018-09-01 |
| 1083107684 | Aakash Deep Gupta | Dentist | 4610 North St Ste 101b, Nacogdoches, TX 75965 | 2018-06-08 |
| 1679097455 | Emily Morris Taravella | Counselor | 3524 Ne Stallings Drive, Nacogdoches, TX 75965 | 2017-08-02 |
| 1457809949 | Kassey Osborn | Nurse Practitioner | 4920 Ne Stallings Dr., Nacogdoches Medical Center, Nacogdoches, TX 75965 | 2016-09-14 |
| 1629426747 | Lisa Greathouse | Technician, Other | 500 Chincapin, Westville, OK 75965 | 2016-05-31 |
| 1457741704 | Nuch of Texas | Pediatrics | 1305 North Street, Nacogdoches, TX 75965 | 2015-01-26 |
| 1730506031 | Benjamin Patrick Thompson | Obstetrics & Gynecology | 4800 Ne Stallings Dr Ste 106, Nacogdoches, TX 75965 | 2014-03-25 |
| 1255761813 | Kallie Krawietz | Counselor | 2214 N Pecan Street, Nacogdoches, TX 75965 | 2013-11-19 |
| Find all providers in zip 75965 | ||||
| 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 |
| 1477807121 | Stephen F. Austin State University | Clinic/Center | 712 Hayter, 13010 Sfa Station, Nacogdoches, TX 75962-3940 | 2012-11-02 |
| 1265501076 | Stephen F. Austin State Univ. Health Service | Clinic/Center | 2106 Raguet St N, Box 13058, Nacogdoches, TX 75962-0001 | 2006-11-07 |
| 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 | 75965 |
Please comment or provide details below to improve the information on STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE.
| 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.