Alabama State University

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

32588 Issued in AL

Legal business name

ALABAMA STATE UNIVERSITY

Doing business as

Alabama State Sports Medicine

Practice address

915 S Jackson St
Montgomery, AL 36104-5716

Phone

(972) 367-4845

NPI assigned

Jun 23, 2017

Last updated

Jun 23, 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 III

Title

Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Alabama State Sports Medicine Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498176000000",
    "number": "1205356938",
    "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": "915 S JACKSON ST",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361045716",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-23",
        "last_updated": "2017-06-23",
        "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",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "AL",
            "license": "32588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alabama State Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alabama Retina
• Alabama Sheriffs' Youth Ranches, Inc.
• Alabama Smiles (The Tooth Zone)
• Alabama Sports, Spine & Occupational Medicine Associates PC
• Alabama State Department of Education
• Alabama Surgical Arts, LLC
• Alabama Surgical Consultants
• Alabama Vascular Specialists, PC
• Alabama Women's Health First, Inc
• Susan Christina Alamin, R N

• Sports Medicine (Orthopaedic Surgery) Physician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.