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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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