# COLORADO MESA UNIVERSITY

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

## Provider details

- **NPI number:** 1629452255
- **Authorized official:** MOUZON BASS III (AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 1100 NORTH AVE, GRAND JUNCTION, CO 81501-3122
- **Practice address phone:** (970) 248-1809
- **Practice address fax:** (972) 367-3452
- **Mailing address:** PO BOX 650850, DEPT 1011, DALLAS, TX 75265-0850
- **Mailing address phone:** (800) 555-9073
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 07/14/2015
- **Last updated:** 07/14/2015