Milligan College

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

000024265 Issued in TN

Legal business name

MILLIGAN COLLEGE

Doing business as

Milligan College Sports Medicine

Practice address

One Blowers Blvd.
Athletics
Milligan College, TN 37682

Phone

(972) 367-4845

NPI assigned

Jul 31, 2017

Last updated

Jul 31, 2017By 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

Title

Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Milligan College Sports Medicine Doing business as

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1063936235",
    "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": "ONE BLOWERS BLVD.",
            "address_2": "ATHLETICS",
            "city": "MILLIGAN COLLEGE",
            "state": "TN",
            "postal_code": "37682",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLIGAN COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "972-367-4845"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TN",
            "license": "000024265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milligan College Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zachary Lance Allen, ATC , MBA
• Kody Eckert, ATC
• Burena Jervene Edens, ATC
• Caleb Johnston, LAT, ATC

• Sports Medicine (Family Medicine) Physician in Milligan College, TN
• Providers in Milligan College, TN by specialty
• Sports Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.