Olivet College

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

5101018837 Issued in MI

Legal business name

OLIVET COLLEGE

Doing business as

Olivet College Sports Medicine

Practice address

320 S Main St
Olivet, MI 49076-9406

Phone

(972) 367-4845

NPI assigned

Mar 30, 2017

Last updated

Mar 30, 2017By 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

• Olivet College Sports Medicine Doing business as

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1689106510",
    "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": "752443995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S MAIN ST",
            "city": "OLIVET",
            "state": "MI",
            "postal_code": "490769406",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVET COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-03-30",
        "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": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101018837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olivet College Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lana J Lewis, D.D.S.
• Main Street Dental PLLC
• Deanna L Mistretta, L.P.N.
• Wendy Jo Murray
• Next Step Home Health and Staffing, LLC
• Olivet Pharmacy Inc (Olivet Pharmacy)
• Olivet Pharmacy LLC (Olivet Pharmacy)
• Britney Page
• Zackary Scott Perry
• Daniel John Peterson, MBA, AT, ATC

• Orthopaedic Surgery Physician in Olivet, MI
• Providers in Olivet, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; 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.