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Organization
FORT HAYS STATE UNIVERSITY
Active
Organization
FORT HAYS STATE UNIVERSITY
Active
Other names
Fort Hays State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
(972) 367-4845
Mailing address
600 PARK ST, #1, HAYS, KS 67601-4009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0537903
KS
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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