Central State University
Organization Active NPI Family Medicine Physician · Wilberforce, OH
NPI 1508244641 · NPPES record last updated May 8, 2015
Key facts
- NPI
- 1508244641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CENTRAL STATE UNIVERSITY
- Practice address
- 1400 Brush Row Rd
Wilberforce, OH 45384-5800 - Phone
- (937) 925-3748
- Fax
- (972) 367-3451
- NPI assigned
- May 8, 2015
- Organization subpart
- No
Authorized official
- Name
- Mouzon Bass III
- Title
- Agent
- Phone
- (972) 367-4845
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Sports Medicine (Family Medicine) Physician |
207QS0010X |
Addresses
Primary practice location
1400 Brush Row Rd
Wilberforce, OH 45384-5800
Mailing address
PO Box 650850
Dallas, TX 75265-0850
Phone (972) 367-4845
Other names
- Central State Sports Medicine
Other providers in Wilberforce, OH
All providers in Wilberforce, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.