| Nicholls State Sports Medicine | |
|
906 E 1st St Thibodaux LA 70301-6701 | |
| (985) 448-4837 | |
| (972) 367-3451 |
| Full Name | Nicholls State Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 906 E 1st St, Thibodaux, Louisiana |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 18005559073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholls State Sports Medicine 5050 Spring Valley Rd Dallas TX 75244-3995 Ph: (800) 555-9073 | Nicholls State Sports Medicine 906 E 1st St Thibodaux LA 70301-6701 Ph: (985) 448-4837 |
| NPI Number | 1861881435 |
|---|---|
| Provider Enumeration Date | 01/20/2015 |
| Last Update Date | 01/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861881435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
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