# WILLIAM PENN UNIVERSITY

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

## Provider details

- **NPI number:** 1902314156
- **Authorized official:** MOUZON BASS III (ADMINISTRATOR)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 201 TRUEBLOOD AVE, OSKALOOSA, IA 52577-1757
- **Practice address phone:** (972) 367-4845
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | DO-05128 | IA | Yes |

## Other

- **Enumeration date:** 01/22/2018
- **Last updated:** 01/22/2018