Northwestern State University

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MD.15580R Issued in LA

Legal business name

NORTHWESTERN STATE UNIVERSITY

Doing business as

NSU Sports Medicine

Practice address

468 Caspari Drive
Natchitoches, LA 71497-0001

Phone

(972) 367-4845

NPI assigned

Nov 6, 2017

Last updated

Nov 6, 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

Administrator

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• NSU Sports Medicine Doing business as

Locations

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509926400000",
    "number": "1306359963",
    "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": "468 CASPARI DRIVE",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714970001",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-06",
        "last_updated": "2017-11-06",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "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": "LA",
            "license": "MD.15580R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NSU Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• New Choice Counseling Center, LLC
• North Louisiana Institutional Pharmacy LLC (Pills in a Pouch)
• Northland Hearing Centers, Inc. (Audibel Hearing Healthcare)
• Northwest Lousiana Human Services District (Natchitoches Behavioral Health Clinic)
• Northwestern Louisiana Cancer Center, L.L.C.
• Nova Vital Natchitoches Recovery Center, LLC
• NRMC Pharmacy Alliance LLC (NRMC Outpatient Pharmacy)
• NRMC Physician Ipa Inc (NRMC Cancer Associates)
• NRMC Physician Ipa Inc (NRMC Urology Associates)
• NRMC Physician Ipa Inc (NRMC Pain Institute)

• Orthopaedic Surgery Physician in Natchitoches, LA
• Providers in Natchitoches, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.