Organization
MUSKINGUM UNIVERSITY
Active
Other names
Muskingum Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
163 STORMONT ST, NEW CONCORD, OH 43762-1118
(740) 826-8211
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/28/2019
Last updated
12/17/2021
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