NPI 1205356938 · live from the CMS NPI Registry
Alabama State University
Orthopaedic Surgery, Sports Medicine in Montgomery, AL. National Provider Identifier 1205356938, active.
NPI record
| NPI | 1205356938 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Orthopaedic Surgery, Sports Medicine 207XX0005X |
| Practice location | 915 S Jackson St, Montgomery, AL 36104 |
| Practice phone | 972-367-4845 |
| Mailing address | 5050 Spring Valley Rd, Dallas, TX 75244 |
| Enumerated | June 23, 2017 |
| Last updated | June 23, 2017 |
| Authorized official | Mouzon Bass, Agent |
| Other names | Alabama State Sports Medicine |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthopaedic Surgery, Sports Medicine primary | 207XX0005X | 32588 (AL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.