# UNIVERSITY OF MONTANA

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

## Provider details

- **NPI number:** 1811386220
- **Authorized official:** MOUZON BASS III (AGENT)
- **Authorized official phone:** 18005559073

## Contact information

- **Practice address:** 37 CAMPUS DR, HOYT COMPLEX, MISSOULA, MT 59812-0001
- **Practice address phone:** (406) 243-6282
- **Practice address fax:** (972) 367-3451
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
- **Mailing address phone:** (800) 555-9073
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 01/22/2015
- **Last updated:** 01/22/2015