NPIMap

Organization Active NPI

Brigham Young University

Doing business as BYU Dance

  • Family Medicine Physician
  • Provo, UT
National Provider Identifier
1790175628
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BRIGHAM YOUNG UNIVERSITY
Doing business as
BYU Dance
Practice address
173 Richards Building
Dance Department
Provo, UT 84602-2000
Phone
(972) 367-4845
Fax
(972) 367-3452
NPI assigned
Jan 30, 2015
Last updated
May 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

173 Richards Building
Dance Department
Provo, UT 84602-2000

Mailing address

5050 Spring Valley Rd
Dallas, TX 75244-3995
Phone (972) 367-4845

Other names 1

  • BYU Dance Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brigham Young University7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

173 Richards Building
Provo, UT 84602
Phone (801) 422-1628

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1790175628",
    "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",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 RICHARDS BUILDING",
            "address_2": "DANCE DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846022000",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHAM YOUNG UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2017-05-11",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BYU Dance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.