Organization
SOUTHWESTERN COLLEGE
Active
Other names
Southwestern College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
100 COLLEGE ST, WINFIELD, KS 67156-2443
(800) 846-1543
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
04-23086
KS
Other
Enumeration date
08/02/2016
Last updated
10/19/2016
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