Jacksonville State University

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

10954 Issued in AL

Legal business name

JACKSONVILLE STATE UNIVERSITY

Doing business as

Jacksonville State University Sports Medicine

Practice address

700 Pelham Rd N
Jacksonville, AL 36265-1602

Phone

(256) 782-5369

NPI assigned

Sep 1, 2016

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

• Jacksonville State University Sports Medicine Doing business as

Locations

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1548717119",
    "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": "700 PELHAM RD N",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362651602",
            "telephone_number": "256-782-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "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": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AL",
            "license": "10954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville State University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacksonville City
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• Jacksonville Medical Professional Services LLC
• Jacksonville Surgical & Medical Affiliates, LLC
• Jennifer Woodard CRNP
• Johnson RX Inc
• David Scott Johnson Jr.
• Olivia Keefe, MS, LAT, ATC

• Sports Medicine (Family Medicine) Physician in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Sports Medicine (Family Medicine) Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.