Organization
EDGEWOOD COLLEGE, INC
Active
Other names
Edgewood College Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1000 EDGEWOOD COLLEGE DR, MADISON, WI 53711-1997
(608) 663-4861
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
64261-21
WI
Other
Enumeration date
10/03/2016
Last updated
10/03/2016
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