| Organization Name: | UNIVERSITY DRIVE HEALTH CENTER, P.A. |
| NPI Number: | 1649289711 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM WAYNE HAIRSTON (OWNER/ PRESIDENT) |
| Mailing Address: | 932 N University Dr Nacogdoches |
| State: | TX US |
| Postal Code: | 759614643 |
| Phone Number: | 9365641188 |
| Fax Number: | 9365604137 |
| NPI Enumeration Date: | 08/06/2006 |
| NPI Last Update Date: | 07/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |