Edward Waters University
Family Medicine, Sports Medicine in Jacksonville, FL. Organization (NPI-2).
Details
- NPI
- 1609596592
- Entity type
- Organization (NPI-2)
- Legal business name
- Edward Waters University
- Organization subpart
- No
- Enumeration date
- Aug 31, 2022
- Certification date
- Aug 29, 2022
- Last updated
- Aug 31, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QS0010X | Family Medicine, Sports Medicine | – | – | Yes |
Other names
- Ewc Sports Medicine (Doing Business As)
Practice location
1658 Kings RdJacksonville, FL 32209-6167
Phone 972-367-4845 · Fax 972-367-3451
Mailing address
15305 Dallas Pkwy Ste 800Addison, TX 75001-6415
Phone 972-367-4845 · Fax 972-367-3451
Authorized official
Mouzon Bass
Ceo/Administrator
9723674845
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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