Mid-America Nazarene University

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

04-28344 Issued in KS

Legal business name

MID-AMERICA NAZARENE UNIVERSITY

Doing business as

Mid-America Nazarene University Sports Medicine

Practice address

5050 Spring Valley Rd.
Dallas, TX 75244-3909

Phone

(972) 367-4845

NPI assigned

Jul 28, 2016

Last updated

Jul 28, 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

Agen

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Mid-America Nazarene University Sports Medicine Doing business as

Tax ID family

Mid-America Nazarene 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.

• Midamerica Nazarene University

  • Athletic Trainer
  • Olathe, KS
  • NPI 1174077465
  NPD tax ID

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1427501238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 E COLLEGE WAY",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660621851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443909",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-AMERICA NAZARENE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-28",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGEN",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "KS",
            "license": "04-28344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-America Nazarene University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Simone Renee Mickens, BST
• Bruce Edward Mickey, MD
• Jessica Mickus, PA-C
• Microsurgery Institute
• Mid Central Neuro Affiliates PLLC
• Midas Health Centers PLLC
• Midas Laboratories, LLC
• Middle Park Emergency Physicians PLLC
• Connor David Middlekauff, PA
• Erin Leah Clara Middlekauff, PA

• Orthopaedic Surgery Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Orthopaedic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.