Organization
CENTRAL CHRISTIAN COLLEGE OF KANSAS
Active
Other names
CCCOK 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
1200 S MAIN ST, MCPHERSON, KS 67460-5740
(972) 367-4845
(972) 367-3451
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
12/17/2021
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