| Nccu Sports Medicine | |
|
1801 Fayetteville St Durham NC 27707-3129 | |
| (919) 530-6215 | |
| (972) 367-3451 |
| Full Name | Nccu Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1801 Fayetteville St, Durham, North Carolina |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nccu Sports Medicine Po Box 650850 Dept 1011 Dallas TX 75265-0850 Ph: (800) 555-9073 | Nccu Sports Medicine 1801 Fayetteville St Durham NC 27707-3129 Ph: (919) 530-6215 |
| NPI Number | 1508237850 |
|---|---|
| Provider Enumeration Date | 10/13/2015 |
| Last Update Date | 10/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508237850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207X00000X | Orthopaedic Surgery | (* (Not Available)) | Secondary |
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