Edward Waters University

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

EDWARD WATERS UNIVERSITY

Practice address

1658 Kings Rd
Jacksonville, FL 32209-6167

Phone

(972) 367-4845

Fax

(972) 367-3451

NPI assigned

Aug 31, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mouzon Bass

Title

Ceo/Administrator

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• EWC SPORTS MEDICINE Doing business as

Locations

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

{
    "created_epoch": "1661904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661904000000",
    "number": "1609596592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1658 KINGS RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096167",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD WATERS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-31",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EWC SPORTS MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edward C. Taylor, PHD. PL
• Edward C. Taylor, PHD. PL
• Edward J Wetzork DC PA
• Edward K McGough MD PA
• Edward Orshansky MD Inc
• Edwards & Cavendish P.a.
• Edwards Chiropractic PA
• Edwards Chiropratic Offices PA
• Edwards Counseling Associates, Corp
• Tamara D Edwards-Cruz, BUSINESS OWNER

• Sports Medicine (Family Medicine) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Sports Medicine (Family Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; 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.