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JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE
NPI 1548717119
Family Medicine - Sports Medicine in Jacksonville, AL

Active since September 01, 2016
700 PELHAM RD N, JACKSONVILLE, AL 36265(256) 782-5369 Get Directions Write a Review

NPPES record last updated: September 1, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jacksonville State University Sports Medicine NPPES

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

JACKSONVILLE STATE UNIVERSITY SPORTS MEDICINE (NPI 1548717119) is a healthcare organization registered as a sports medicine in Jacksonville, Alabama and active in the NPI registry since September 2016. The organization lists Mouzon Bass, Agent, as its authorized official.

NPPES Registry Identity

NPI1548717119
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameJACKSONVILLE STATE UNIVERSITY
Location Address700 PELHAM RD NJacksonville, AL 36265-1602
Mailing Address5050 Spring Valley Rd.Dallas, TX 75244-3909
Phone(256) 782-5369
Organization SubpartNo
Authorized OfficialMouzon BassAgent · (972) 367-4845
Enumeration DateSeptember 1, 2016
✔ NPI 1548717119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
License✔ Licensed in AL · 10954
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
700 PELHAM RD N, Jacksonville, AL 36265
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Other Names 1

Doing Business AsJacksonville 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

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENAH TRACY
Specialist/Technologist (Athletic Trainer)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (239) 227-9632
ANTHONY TAYLOR PACK ATC, LAT
Specialist/Technologist (Athletic Trainer)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 782-5582
LEISHA HANCOCK
Student in an Organized Health Care Education/Training Program
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 601-0673
JACOB LOUIS PHILLIPS
Student in an Organized Health Care Education/Training Program
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 424-1466
MICHAEL GARRETT POLASCIK ATC
Specialist/Technologist (Athletic Trainer)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 782-5369
DUSTIN HILL ATC, LAT
Specialist/Technologist (Athletic Trainer)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 782-5369
MICHAELA GRACE MEADOWS ATC, LAT
Physical Medicine & Rehabilitation (Sports Medicine)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (256) 782-5526
MRS. ASHLEY ELIZABETH ASBURY MSAT, LAT, ATC
Specialist/Technologist (Athletic Trainer)
700 PELHAM RD N
JACKSONVILLE, AL 36265
Calhoun County (816) 868-3563

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 Jacksonville State University's NPI number?

The NPI number for Jacksonville State University is 1548717119. It was assigned to this organization in the NPPES registry on September 1, 2016. The provider is doing business as Jacksonville State University Sports Medicine.

Where is Jacksonville State University located?

Jacksonville State University is located at 700 Pelham Rd N, Jacksonville, AL 36265. The listed phone number is (256) 782-5369.

What is Jacksonville State University's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

When was this NPI record last updated?

The NPPES record for Jacksonville State University was last updated on September 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.