Organization
LINDSEY WILSON COLLEGE, INC
Active
Other names
Lindsey Wilson College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
210 LINDSEY WILSON ST, COLUMBIA, KY 42728-1223
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
40622
KY
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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