Organization
BLOOMSBURG UNIVERSITY SPEECH & HEARING CLINIC
Active
Other names
Bloomsburg Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
400 E 2ND ST, BLOOMSBURG, PA 17815-1301
(570) 389-4000
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
12/17/2021
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