Letourneau University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LETOURNEAU UNIVERSITY

Practice address

2100 S Mobberly Ave
Longview, TX 75602-3564

Phone

(903) 233-3760

Fax

(972) 367-3451

NPI assigned

Jan 20, 2015

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

(800) 555-9073

Specialties & licenses 2

Addresses

Other names 1

• letu sports medicine Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Portia Phillips

  • Athletic Trainer
  • Longview, TX
  • NPI 1659807287
  NPD (past)

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1932598513",
    "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": "800-555-9073",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S MOBBERLY AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756023564",
            "telephone_number": "903-233-3760",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LETOURNEAU UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "18005559073",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "letu sports medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Leineweber, LCSW
• Molly Lopez Lemaire
• Lanie Lenhart, MS, CCC-SLP
• Amanda Lester, LCSW
• Sammantha Lestig, LMT, CPEP
• Lets Grow Kids Clinic
• Amy Lett
• Jonathan Leung
• Lewis a Browne MD PA
• Lewis Chiropractic Clinic

• Family Medicine Physician in Longview, TX
• Providers in Longview, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.