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NPI Code Detail

MEDICARE: MISSOURI WESTERN STATE UNIVERSITY

MEDICARE: MISSOURI WESTERN STATE UNIVERSITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician
2207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1063891158
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI WESTERN STATE UNIVERSITY
Provider Business Mailing Address
First Line : PO BOX 650850
Second Line : DEPT 1011
City : DALLAS
State : TX
Zip : 75265-0850
Country : US
Telephone Number : 800-555-9073
Fax Number : 972-367-3452
Provider Business Practice Location Address
First Line : 4525 DOWNS DR
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64507-2246
Country : US
Telephone Number : 816-271-4597
Fax Number : 972-367-3451
Authorized Official
Title or Position : AGENT
Name : MOUZON BASS
Credential :
Telephone Number : 972-367-4845
Provider Enumeration Date : 05/22/2015
Last Update Date : 05/22/2015

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Directions to “MISSOURI WESTERN STATE UNIVERSITY ” Practice Location

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