Brevard College

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

BREVARD COLLEGE

Doing business as

Brevard College Athletics

Practice address

1 Brevard College Dr
Brevard, NC 28712-4283

Phone

(972) 367-4845

NPI assigned

Mar 18, 2022

Last updated

Mar 18, 2022By 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

Mr. Mouzon Bass

Title

Administrator/Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• BREVARD COLLEGE ATHLETICS Doing business as

Tax ID family

Brevard College2 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.

• Brevard College

  dba Brevard College Student Health Center

  • Family Medicine Physician
  • Brevard, NC
  • NPI 1093456113
  NPD tax ID

Locations

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

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1831848860",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BREVARD COLLEGE DR",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287124283",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-18",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "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_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": "BREVARD COLLEGE ATHLETICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Lauren Boulos, LCAS, LCSW
• David T Braun, M.D.
• Jacquelyn Lee Bray, D.MIN, LPC
• Brevard Chiropractic Center PA
• Brevard College (Brevard College Student Health Center)
• Brevard Drug Company LLC (Brevard Drug Company)
• Brevard Hearing Center of North Carolina PLLC
• Brevard Hearing Center, LLC
• Brevard NC Opco LLC
• Brevard North Operating Al, LLC (Kingsbridge House)

• Sports Medicine (Family Medicine) Physician in Brevard, NC
• Providers in Brevard, NC by specialty
• Sports Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.