| NPI | 1194198192 |
|---|---|
| Doing Business As | NORTHEASTERN STATE UNIVERSITY SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |