Provider Demographics
NPI:1215519368
Name:SAM HOUSTON STATE UNIVERSITY
Entity type:Organization
Organization Name:SAM HOUSTON STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-525-3600
Mailing Address - Street 1:2424 SAM HOUSTON AVE SUITE B8
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77341-0001
Mailing Address - Country:US
Mailing Address - Phone:936-294-3788
Mailing Address - Fax:
Practice Address - Street 1:2424 SAM HOUSTON AVE SUITE B8
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77341-0001
Practice Address - Country:US
Practice Address - Phone:936-294-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAM HOUSTON STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory