# NORTHWESTERN STATE UNIVERSITY

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

## Provider details

- **NPI number:** 1306359963
- **Authorized official:** MOUZON BASS III (ADMINISTRATOR)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 468 CASPARI DRIVE, NATCHITOCHES, LA 71497-0001
- **Practice address phone:** (972) 367-4845
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | MD.15580R | LA | Yes |

## Other

- **Enumeration date:** 11/06/2017
- **Last updated:** 11/06/2017