Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Glenville State College

Organization Sports Medicine (Internal Medicine) Physician · NPI 1043850191

Glenville State College is a Sports Medicine (Internal Medicine) Physician in Glenville, West Virginia. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

200 High St
Glenville, WV 26351-1200
Phone: (972) 367-4845
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Internal Medicine) Physician (primary) Taxonomy 207RS0010X

Record details

NPI number1043850191
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Administrator/Agent · (972) 367-4845
Other names Glenville Sports Medicine
NPI enumeratedJanuary 7, 2020
Last updated in NPPESJanuary 7, 2020
Certification dateJanuary 7, 2020
Mailing address5050 Spring Valley Rd, Dallas, TX 75244-3995