Oklahoma City University

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

OKLAHOMA CITY UNIVERSITY

Doing business as

OKCU Sports Medicine

Practice address

2501 N Blackwelder Ave
Oklahoma City, OK 73106-1402

Phone

(972) 367-4845

NPI assigned

Sep 18, 2018

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

• OKCU Sports Medicine Doing business as

Tax ID family

Okcu Sports Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Oklahoma City University

  • Student Health Clinic/Center
  • Oklahoma City, OK
  • NPI 1699932228
  NPD tax ID
• Oklahoma City University Campus Health

  • Student Health Clinic/Center
  • Oklahoma City, OK
  • NPI 1639591639
  NPD tax ID

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1285118174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415",
            "telephone_number": "972-367-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N BLACKWELDER AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731061402",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA CITY UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "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": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OKCU Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OKCU Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Oklahoma City Pain Management PLLC
• Oklahoma City Public Schools
• Oklahoma City Public Schools
• Oklahoma City Rehabilitation Hospital, LLC
• Oklahoma City Surgery Center LP
• Oklahoma City University
• Oklahoma City University Campus Health
• Oklahoma City VA Healthcare System
• Oklahoma City VA Hospital
• Oklahoma City Vamc

• Orthopaedic Surgery Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Orthopaedic Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.