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General NPI Number Information
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NPI Number | 1740491497
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Entity Type | Organization
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Legal Business Name | SAM HOUSTON STATE UNIVERSITY
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 1608 AVENUE J
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City | HUNTSVILLE
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State | TX
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Zip | 77340-5227
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Country | US
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Telephone | 936-294-1803
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Fax | 936-294-3971
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Provider Business Mailing Address
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Address Line | 1608 AVENUE J PO BOX 2358
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City | HUNTSVILLE
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State | TX
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Zip | 77340-5227
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Country | US
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Telephone | 936-294-1843
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Fax | 936-294-3971
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR HEALTH AND WELLB
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Name | ERICA BUMPURS
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Credential |
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Telephone | 936-294-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 08007
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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