1477928810 NPI number — NMS WEIGHTLOSS CLINIC II LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477928810 NPI number — NMS WEIGHTLOSS CLINIC II LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NMS WEIGHTLOSS CLINIC II LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477928810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6150 DIAMOND CENTRE COURT
Provider Second Line Business Mailing Address:
BLDG #400
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-333-0828
Provider Business Mailing Address Fax Number:
239-561-9188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 CYPRESS WAY E
Provider Second Line Business Practice Location Address:
SUITE 45
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-9275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-325-1633
Provider Business Practice Location Address Fax Number:
239-325-1630
Provider Enumeration Date:
12/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BLOY
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
239-333-0828

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L07000111368 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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