# EMPORIA STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Emporia State University Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164879821
- **Authorized official:** MOUZON BASS III (AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3909
- **Practice address phone:** (972) 367-4845
- **Mailing address:** 1 KELLOGG CIR, EMPORIA, KS 66801-5415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/23/2016
- **Last updated:** 05/31/2016