# SALVE REGINA UNIVERSITY

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

## Provider details

- **NPI number:** 1881112027
- **Authorized official:** MOUZON BASS III (AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 100 OCHRE POINT AVE, NEWPORT, RI 02840-4149
- **Practice address phone:** (972) 367-4845
- **Mailing address:** 15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
- **Mailing address phone:** (972) 367-4845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 15220 | RI | Yes |

## Other

- **Enumeration date:** 09/08/2017
- **Last updated:** 12/17/2021