McNeese State University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MCNEESE STATE UNIVERSITY

Doing business as

McNeese Sports Medicine

Practice address

700 E McNeese St
Lake Charles, LA 70607-5832

Phone

(972) 367-4845

NPI assigned

Sep 4, 2018

Last updated

Dec 17, 2021By 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

Administrator/Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• McNeese Sports Medicine Doing business as

Tax ID family

Kay Dore Counseling Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Kay Dore Counseling Clinic

  • Mental Health Counselor
  • Lake Charles, LA
  • NPI 1750705935
  NPD tax ID
• McNeese State University

  • Community/Behavioral Health Agency
  • Lake Charles, LA
  • NPI 1851616262
  NPD tax ID

Locations

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1750863957",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E MCNEESE ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706075832",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCNEESE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-04",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McNeese Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Lavonne McLurkin, M.D.
• Lashanda McMahon
• Brian McMillin, HIS
• Matthew C, McNally, MA, LPC
• Tracy Weatherford McNeely, LCSW
• McNeese State University
• Elvina Bias McZeal
• MDL Med Corp LLC
• Meche and Callaba Therapeutic Services, LLC
• Dylan Jay Meche, D.C.

• Family Medicine Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.