OrganizationActive
Edward Waters University
NPI 1609596592 · Sports Medicine (Family Medicine) Physician · Jacksonville, FL
Provider details
- NPI number
- 1609596592
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mouzon Bass, Ceo/Administrator(972) 367-4845
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1658 Kings Rd
Jacksonville, FL 32209-6167
Phone: (972) 367-4845
Fax: (972) 367-3451
Approximate (ZIP-level) locationGet directions
Mailing address
15305 Dallas Pkwy Ste 800
Addison, TX 75001-6415
Other names (DBA / former)
- Doing business as
- Ewc Sports Medicine
Registry dates
- Enumerated
- 2022-08-31
- Last updated
- 2022-08-31
- Certified
- 2022-08-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.