Organization
PITTSBURG STATE UNIVERSITY
Active
Other names
Pittsburg State University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1701 S BROADWAY ST, 110 RUSS HALL, PITTSBURG, KS 66762-5856
(620) 231-7000
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
04-28648
KS
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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