| Saint Martin's University Athletics | |
|
5000 Abbey Way Se Lacey WA 98503-3200 | |
| (972) 367-4845 | |
| Not Available |
| Full Name | Saint Martin's University Athletics |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 5000 Abbey Way Se, Lacey, Washington |
| Authorized Official Name and Position | Mouzon Bass III (ADMINISTRATOR/AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Saint Martin's University Athletics 15305 Dallas Pkwy Ste 800 Addison TX 75001-6415 Ph: (972) 367-4845 | Saint Martin's University Athletics 5000 Abbey Way Se Lacey WA 98503-3200 Ph: (972) 367-4845 |
| NPI Number | 1023898483 |
|---|---|
| Provider Enumeration Date | 10/03/2023 |
| Last Update Date | 10/03/2023 |
| Certification Date | 10/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023898483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (NU) | Primary |
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