Lindenwood University-Belleville

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

036129925 Issued in IL

Legal business name

LINDENWOOD UNIVERSITY-BELLEVILLE

Doing business as

Lindenwood University-Belleville Sports Medicine

Practice address

2600 W Main St
Belleville, IL 62226-6651

Phone

(972) 367-4845

NPI assigned

Oct 27, 2016

Last updated

Oct 27, 2016By 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

• Lindenwood University-Belleville Sports Medicine Doing business as

Tax ID family

Lindenwood University2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lindenwood University

  dba Lindenwood University Sports Medicine

  • Orthopaedic Surgery Physician
  • Saint Charles, MO
  • NPI 1831646397
  NPD tax ID

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1316499155",
    "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": "752443909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622266651",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINDENWOOD UNIVERSITY-BELLEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IL",
            "license": "036129925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lindenwood University-Belleville Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hanna Jo Liljegren, PA-C
• Christine Lin, D.O.
• Lincoln Place Dental PC
• Lincoln Surgical Group
• Joanna Marie Lindauer, FNP-C
• Stephanie Lynn Link, DO
• Little Lanterns ABA LLC
• Emily Grace Little, SLP
• Cynthia Ann Littlefield, DMD
• Mary C. Littlejohn, APN

• Sports Medicine (Orthopaedic Surgery) Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.