Pittsburg State University

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

04-28648 Issued in KS

Legal business name

PITTSBURG STATE UNIVERSITY

Practice address

1701 S Broadway St
110 Russ Hall
Pittsburg, KS 66762-5856

Phone

(620) 231-7000

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

• Pittsburg State University Sports Medicine Doing business as

Tax ID family

Pittsburg State University2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Psu Student Health Center

  • Internal Medicine Physician
  • Pittsburg, KS
  • NPI 1710273388
  NPD tax ID

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": "1821544479",
    "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",
            "telephone_number": "972-367-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S BROADWAY ST",
            "address_2": "110 RUSS HALL",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667625856",
            "telephone_number": "620-231-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PITTSBURG 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": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "KS",
            "license": "04-28648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pittsburg State University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pittsburg Chiropractic Center LLC
• Pittsburg Emergency Physicians, LLC
• Pittsburg Imaging Center, LLC
• Pittsburg Internal Medicine, P.a.
• Pittsburg Operator, LLC
• Pittsburg Usd250
• Christina M Platt-Waggoner
• Barry James Plumlee, LMFT
• Jean-Daniel Policard, M.D.
• Ethan Powell, OD

• Orthopaedic Surgery Physician in Pittsburg, KS
• Providers in Pittsburg, KS by specialty
• Orthopaedic Surgery Physician in Kansas

• 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.