Ottawa Sports Medicine | |
15950 N. Civ Center Plaza Surprize AZ 85374 | |
(972) 367-4845 | |
Not Available |
Full Name | Ottawa Sports Medicine |
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Speciality | General Practice |
Location | 15950 N. Civ Center Plaza, Surprize, Arizona |
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 |
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Ottawa Sports Medicine 5050 Spring Valley Rd Dallas TX 75244-3995 Ph: () - | Ottawa Sports Medicine 15950 N. Civ Center Plaza Surprize AZ 85374 Ph: (972) 367-4845 |
NPI Number | 1346751351 |
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Provider Enumeration Date | 10/17/2017 |
Last Update Date | 10/17/2017 |
Identifier | Type | State | Issuer |
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1346751351 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | 31375 (Arizona) | Primary |