# STEPHEN F AUSTIN STATE UNIVERSITY SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063727048
- **Authorized official:** SANDY MILLER ATC (ASST AD FOR SPORTS MEDICINE)
- **Authorized official phone:** (936) 468-4550

## Contact information

- **Practice address:** 1936 NORTH ST, SFA SPORTS MEDICINE CLINIC, NACOGDOCHES, TX 75965-3940
- **Practice address phone:** (936) 468-4550
- **Practice address fax:** (936) 468-4052
- **Mailing address:** 1936 NORTH ST, SFA SPORTS MEDICINE CLINIC, NACOGDOCHES, TX 75965-3940
- **Mailing address phone:** (936) 468-4550
- **Mailing address fax:** (936) 468-4052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/13/2010
- **Last updated:** 08/13/2010