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815 W Market St Greensboro NC 27401-1823 | |
| (972) 367-4845 | |
| (972) 367-3451 |
| Full Name | |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 815 W Market St, Greensboro, North Carolina |
| Authorized Official Name and Position | Mouzon Bass (ADMINISTRATOR/AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15305 Dallas Pkwy Ste 800 Addison TX 75001-6415 Ph: (972) 367-4845 | 815 W Market St Greensboro NC 27401-1823 Ph: (972) 367-4845 |
| NPI Number | 1689305245 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 06/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689305245 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
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