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Contact Information

EDWARD WATERS UNIVERSITY
1658 KINGS RD
JACKSONVILLE, FL32209-6167
 Phone: 972-367-4845
 Fax: 972-367-3451
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for EDWARD WATERS UNIVERSITY

NPI # 1609596592
LBN Legal business name EDWARD WATERS UNIVERSITY
Authorized official MOUZON BASS - (CEO/ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 08/31/2022
Last updated 08/31/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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