Organization
SAM HOUSTON STATE UNIVERSITY
Active
Parent organization
SAM HOUSTON STATE UNIVERSITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAM HOUSTON STATE UNIVERSITY
Authorized official
AMANDA WITHERS (CFO AND SR VP FOR OPERATIONS)
(936) 294-2686
Entity
Organization
Contact information
Practice address
1169 GRAND CENTRAL PKWY, CONROE, TX 77304-3185
(936) 525-3600
(936) 525-3624
Mailing address
1169 GRAND CENTRAL PKWY, CONROE, TX 77304-3185
(936) 525-3600
(936) 525-3624
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
2080P0207X
Pediatric Hematology & Oncology Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
10/07/2024
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