Organization
SNOW COLLEGE
Active
Other names
Snow College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III HANDY (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
150 E. COLLEGE WAY, EPHRAIM, UT 84627
(800) 555-9073
(972) 367-3452
Mailing address
PO BOX 650850, DALLAS, TX 75265-0850
(972) 367-4845
(972) 367-3451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
08/18/2015
Last updated
10/09/2015
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