1. Home
  2. Directory
  3. Mississippi
  4. Jackson
  5. General Practice
  6. NPI Profile

JACKSON STATE UNIVERSITY SPORTS MEDICINE
NPI 1366991523
General Practice in Jackson, MS

Active since September 29, 2016
1400 JR LYNCH ST, JACKSON, MS 39217(601) 979-2291 Get Directions Write a Review

NPPES record last updated: September 29, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jackson State University Sports Medicine NPPES

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

JACKSON STATE UNIVERSITY SPORTS MEDICINE (NPI 1366991523) is a healthcare organization registered as a general practice in Jackson, Mississippi and active in the NPI registry since September 2016. The organization lists Mouzon Bass, Agent, as its authorized official.

NPPES Registry Identity

NPI1366991523
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameJACKSON STATE UNIVERSITY
Location Address1400 JR LYNCH STJackson, MS 39217-0002
Mailing Address5050 Spring Valley RdDallas, TX 75244-3995
Phone(601) 979-2291
Organization SubpartNo
Authorized OfficialMouzon BassAgent · (972) 367-4845
Enumeration DateSeptember 29, 2016
✔ NPI 1366991523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in MS · 09707
Definition

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

1400 JR LYNCH ST, Jackson, MS 39217
Open in Google Maps ↗

Other Names 1

Doing Business AsJackson State University 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 Jackson State University's NPI number?

The NPI number for Jackson State University is 1366991523. It was assigned to this organization in the NPPES registry on September 29, 2016. The provider is doing business as Jackson State University Sports Medicine.

Where is Jackson State University located?

Jackson State University is located at 1400 Jr Lynch St, Jackson, MS 39217. The listed phone number is (601) 979-2291.

What is Jackson State University's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Jackson State University was last updated on September 29, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.