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

Southeast Missouri State University

Organization Sports Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1871003301

Southeast Missouri State University is a Sports Medicine (Physical Medicine & Rehabilitation) Physician in Cape Girardeau, Missouri. Licensed in Missouri. Registered with an NPI since 2017.

Licensed in
MO
In the registry since
2017

Practice location Address checks out

1 University Plz # MS 0200
Cape Girardeau, MO 63701-4710
Phone: (972) 367-4845
Show map & directions

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

Specialties & licences

Sports Medicine (Physical Medicine & Rehabilitation) Physician (primary) Taxonomy 2081S0010X · Licence 2007008844 (MO)

Record details

NPI number1871003301
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Agent · (972) 367-4845
Other names Semo State Sports Medicine
NPI enumeratedOctober 11, 2017
Last updated in NPPESDecember 17, 2021
Certification dateDecember 17, 2021
Mailing address15305 Dallas Pkwy Ste 800, Addison, TX 75001-6415

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