ST. BONAVENTURE SPORTS MEDICINE - NPI 1710407945 - Orthopaedic Surgery in Saint Bonaventure, NY

Q: What is St. Bonaventure University's NPI number?

The NPI number for St. Bonaventure University is 1710407945. It was assigned to this organization in the NPPES registry on June 20, 2017. The provider is doing business as St. Bonaventure Sports Medicine.

Q: What is St. Bonaventure University's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

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About St. Bonaventure Sports Medicine NPPES

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

ST. BONAVENTURE SPORTS MEDICINE (NPI 1710407945) is a healthcare organization registered as an orthopaedic surgery in Saint Bonaventure, New York and active in the NPI registry since June 2017. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Mouzon Bass, Agent, as its authorized official.

NPPES Registry Identity

NPI1710407945

Entity TypeOrganization

Primary Taxonomy207X00000X

Legal Business NameST. BONAVENTURE UNIVERSITY

Location Address3261 W STATE RDSaint Bonaventure, NY 14778-9800

Mailing Address5050 Spring Valley RdDallas, TX 75244-3995 · (972) 367-4845

Phone(972) 367-4845

Organization SubpartNo

Authorized OfficialMouzon BassAgent · (972) 367-4845

Enumeration DateJune 20, 2017

✔ NPI 1710407945 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207X00000X

License✔ Licensed in NY · 211943-2

Definition

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

3261 W STATE RD, Saint Bonaventure, NY 14778

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Other Names 1

Doing Business AsSt. Bonaventure 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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2187924

St Bonaventure University Center For Student Wellness · St Bonaventure, NY

Active · expires Mar 26, 2027

CLIA Number33D2187924

Laboratory TypeSchool/Student Health Service

Certificate Effective DateJuly 9, 2020

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorFrancesca T. Parry

Laboratory Phone(716) 375-2310

Laboratory LocationSt Bonaventure University Center For Student Wellness3261 W State Rd - Doyle Hall, St Bonaventure, NY 14778

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

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

MATT SMITH LAT, ATC

Specialist/Technologist (Athletic Trainer)