| Organization Name: | STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE |
| NPI Number: | 1063727048 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDY MILLER (ASST AD FOR SPORTS MEDICINE) |
| Mailing Address: | 1936 North St Sfa Sports Medicine Clinic Nacogdoches |
| State: | TX US |
| Postal Code: | 759653940 |
| Phone Number: | 9364684550 |
| Fax Number: | 9364684052 |
| NPI Enumeration Date: | 08/13/2010 |
| NPI Last Update Date: | 08/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Student Health |
| Taxonomy Definition: | |