JACKSON STATE UNIVERSITY NPI 1366991523

NPI Information

JACKSON STATE UNIVERSITY is a general practice in Jackson, MS. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee JACKSON STATE UNIVERSITY NPI is 1366991523. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Jackson State University Sports Medicine.

The provider's business location address is:

1400 JR LYNCH ST
JACKSON, MS
ZIP 39217-002
Phone: (601) 979-2291

The provider's authorized official is Mouzon Bass .
The authorized official title is Agent and has the following contact phone number (972) 367-4845.

The CLIA number assigned to this NPI record is 25D1032113 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/29/2016 and was last updated on 9/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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