Organization
LIBERTY UNIVERSITY, INC
Active
Other names
LUCS 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
1971 UNIVERSITY BLVD, LYNCHBURG, VA 24515-0002
(434) 582-2100
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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