Glenville State College

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

Legal business name

GLENVILLE STATE COLLEGE

Doing business as

Glenville Sports Medicine

Practice address

200 High St
Glenville, WV 26351-1200

Phone

(972) 367-4845

NPI assigned

Jan 7, 2020

Last updated

Jan 7, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mouzon Bass III

Title

Administrator/Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Glenville Sports Medicine Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1043850191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HIGH ST",
            "city": "GLENVILLE",
            "state": "WV",
            "postal_code": "263511200",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENVILLE STATE COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenville Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gilmer County Board of Education
• Gilmer County Board of Health (Gilmer County Health Department)
• Gilmer County Health Department
• Glenville Family Dentistry PLLC
• Glenville SNF Operations LLC (Glenville Health & Rehabilitation)
• Glenville State University
• Robin Goodrich
• Macy Nichole Gregory, PHARMD
• Corrie Elizabeth Grogg, WHNP-BC, FNP-C
• Aimee G Hartshorn, PHARM D

• Sports Medicine (Internal Medicine) Physician in Glenville, WV
• Providers in Glenville, WV by specialty
• Sports Medicine (Internal Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.