Glenville State College
Organization Active NPI Sports Medicine (Internal Medicine) Physician · Glenville, WV
NPI 1043850191 · NPPES record last updated Jan 7, 2020
Key facts
- NPI
- 1043850191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Internal Medicine) Physician 207RS0010X
- Legal business name
- GLENVILLE STATE COLLEGE
- Practice address
- 200 High St
Glenville, WV 26351-1200 - Phone
- (972) 367-4845
- NPI assigned
- Jan 7, 2020
- Organization subpart
- No
Authorized official
- Name
- Mouzon Bass III
- Title
- Administrator/Agent
- Phone
- (972) 367-4845
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Internal Medicine) Physician |
207RS0010X | Yes |
Addresses
Primary practice location
200 High St
Glenville, WV 26351-1200
Mailing address
5050 Spring Valley Rd
Dallas, TX 75244-3995
Other names
- Glenville Sports Medicine
Other providers in Glenville, WV
- Gilmer County Board of Education
- Gilmer County Board of Health
- Gilmer County Health Department
- Glenville Family Dentistry PLLC
- Glenville SNF Operations LLC
- Glenville State University
- Robin Goodrich
- Macy Nichole Gregory
- Corrie Elizabeth Grogg
- Aimee G Hartshorn
All providers in Glenville, WV · Sports Medicine (Internal Medicine) Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.