Organization
FORT HAYS STATE UNIVERSITY
Active
Other names
Fort Hays State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
(972) 367-4845
Mailing address
600 PARK ST, #1, HAYS, KS 67601-4009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0537903
KS
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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