MEDICARE: TEXAS SOUTHERN 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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	N3308	TX

General Provider Information

NPI Number	:	1720435308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS SOUTHERN UNIVERSITY

Provider Business Mailing Address
First Line	:	5050 SPRING VALLEY RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-3909
Country	:	US
Telephone Number	:	972-367-4845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 CLEBURNE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4501
Country	:	US
Telephone Number	:	713-313-7011
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	MOUZON BASS III
Credential	:
Telephone Number	:	972-367-4845

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

Similar Medicare Providers

1205149606 — MR. JOHN WESLEY HARVEY MS,LAT,ATC
Practice Location Address:

3100 CLEBURNE ST
HOUSTON, TX
77004-4501

Practice Phone: 713-313-7123
Practice Fax: 713-313-1045

1669785853 — TEXAS SOUTHERN UNIVERSITY
Practice Location Address:

3100 CLEBURNE ST , STUDENT HEALTH CENTER
HOUSTON, TX
77004-4501

Practice Phone: 713-313-7173
Practice Fax: 713-313-7817

1447986856 — ZAKIYA ATIYAH
Practice Location Address:

3100 CLEBURNE ST
HOUSTON, TX
77004-4501

Practice Phone: --
Practice Fax:

1083340483 — AN THIEN PHAN
Practice Location Address:

3100 CLEBURNE ST
HOUSTON, TX
77004-4501

Practice Phone: 832-212-0165
Practice Fax:

1548996994 — MARRANDA THOMAS
Practice Location Address:

3100 CLEBURNE ST # 130D
HOUSTON, TX
77004-4501

Practice Phone: 713-313-7444
Practice Fax:

1205562451 — EMANI ANGEL GASPER
Practice Location Address:

3100 CLEBURNE ST
HOUSTON, TX
77004-4501

Practice Phone: 713-313-7444
Practice Fax:

Directions to “TEXAS SOUTHERN UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.