Organization
BENEDICTINE COLLEGE
Active
Other names
Benedictine College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1020 N 2ND ST RM 103, ATCHISON, KS 66002-1402
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
04-29855
KS
Other
Enumeration date
07/19/2017
Last updated
07/21/2022
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