# LIBERTY UNIVERSITY, INC

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

## Provider details

- **NPI number:** 1689296360
- **Authorized official:** MOUZON BASS III (ADMINISTRATOR/AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 1971 UNIVERSITY BLVD, LYNCHBURG, VA 24515-0002
- **Practice address phone:** (434) 582-2100
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995

## 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:** 05/15/2020
- **Last updated:** 05/15/2020