Organization
THE UNIVERSITY OF SOUTH CAROLINA
Active
Other names
USC Upstate sports medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
18005559073
Entity
Organization
Contact information
Practice address
800 UNIVERSITY WAY, GB HODGE CENTER, SPARTANBURG, SC 29303-4932
(864) 503-5104
(972) 367-3451
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
01/20/2015
Last updated
01/20/2015
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