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Organization
SOUTHWESTERN ASSEMBLIES OF GOD UNIVERSITY
Active
Organization
SOUTHWESTERN ASSEMBLIES OF GOD UNIVERSITY
Active
Other names
SAGU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1200 SYCAMORE ST, WAXAHACHIE, TX 75165-2397
(972) 825-4671
(972) 367-3451
Mailing address
PO BOX 650850, DEPT 1011, DALLAS, TX 75265-0850
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
06/01/2015
Last updated
06/01/2015
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