# NORTHWEST COLLEGE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTHWEST COLLEGE ATHLETICS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417651183
- **Authorized official:** MR. MOUZON BASS III (ADMINISTRATOR)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 231 W 6TH ST BLDG 1, POWELL, WY 82435-1898
- **Practice address phone:** (972) 367-4845
- **Mailing address:** 15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
- **Mailing address phone:** (972) 367-4845
- **Mailing address fax:** (972) 367-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2023
- **Last updated:** 03/28/2023