# SOUTHERN VIRGINIA UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SVU Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083015960
- **Authorized official:** MOUZON BASS III (ADMINISTRATOR/AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 1 UNIVERSITY HILL DR, KNIGHT SPORTS ARENA, BUENA VISTA, VA 24416-3038
- **Practice address phone:** (540) 261-4931
- **Practice address fax:** (540) 266-3866
- **Mailing address:** 15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
- **Mailing address phone:** (972) 367-4845

## Taxonomy

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

## Other

- **Enumeration date:** 09/10/2014
- **Last updated:** 12/17/2021