1. Home
  2. Directory
  3. Tennessee
  4. Johnson City
  5. Family Medicine
  6. NPI Profile

ETSU SPORTS MEDICINE
NPI 1285264531
Family Medicine in Johnson City, TN

Active since January 24, 2020
1081 JOHN ROBERT BELL DR, RM W-127, JOHNSON CITY, TN 37614(972) 367-4845 Get Directions Write a Review

NPPES record last updated: December 17, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 17, 2021, Jan 13, 2021, Jan 24, 2020 (3 updates tracked since 2020).

About Etsu Sports Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETSU SPORTS MEDICINE (NPI 1285264531) is a healthcare organization registered as a family medicine in Johnson City, Tennessee and active in the NPI registry since January 2020. The organization lists Mouzon Bass, Administrator/agent, as its authorized official.

NPPES Registry Identity

NPI1285264531
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEAST TENNESSEE STATE UNIVERSITY
Location Address1081 JOHN ROBERT BELL DR, RM W-127Johnson City, TN 37614
Mailing Address15305 Dallas Pkwy Ste 800Addison, TX 75001-6415 · (972) 367-4845
Phone(972) 367-4845
Organization SubpartNo
Authorized OfficialMouzon BassAdministrator/agent · (972) 367-4845
Enumeration DateJanuary 24, 2020
Last NPPES UpdateDecember 17, 20213 updates tracked since enumeration
NPPES CertifiedDecember 17, 2021
✔ NPI 1285264531 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1081 JOHN ROBERT BELL DR, Johnson City, TN 37614
Open in Google Maps ↗

Other Names 1

Doing Business AsEtsu Sports Medicine

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Tennessee State University's NPI number?

The NPI number for East Tennessee State University is 1285264531. It was assigned to this organization in the NPPES registry on January 24, 2020. The provider is doing business as Etsu Sports Medicine.

Where is East Tennessee State University located?

East Tennessee State University is located at 1081 John Robert Bell Dr Rm W-127, Johnson City, TN 37614. The listed phone number is (972) 367-4845.

What is East Tennessee State University's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for East Tennessee State University was last updated on December 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.