Northeastern State University Sports Medicine

LBN: Northeastern State University
Northeastern State University Sports Medicine is an health care organization with primary practice located at 603 N Grand Ave , Tahlequah OK 74464-2302. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is the primary health care specialty. Northeastern State University can be contacted via phone (918) 444-3921, or through Bass, Mouzon via phone (972) 367-4845.

Contact Information

Primary practice address
603 N Grand Ave Tahlequah OK 74464-2302
Phone: (918) 444-3921
Fax: (972) 367-3451
Website:
Map and Directions
Authorized official contact:
Name: Bass, Mouzon
Phone: (972) 367-4845

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X

Profile Details

NPI number 1194198192
LBN Legal business name Northeastern State University
DBA Doing business as Northeastern State University Sports Medicine
Authorized official Bass, Mouzon
Entity Organization
Organization subpart 1 No
Enumeration date Nov 12th, 2015
Last updated Nov 12th, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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