1841664208 NPI number — PARK CITIES WEIGHTLOSS CLINIC, LLC

Table of content: (NPI 1841664208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841664208 NPI number — PARK CITIES WEIGHTLOSS CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK CITIES WEIGHTLOSS CLINIC, 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:
1841664208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 SHADY OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-271-4154
Provider Business Mailing Address Fax Number:
817-697-1595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6170 SHERRY LN
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-6350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-253-0029
Provider Business Practice Location Address Fax Number:
214-466-6806
Provider Enumeration Date:
11/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OREN
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
JOEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-271-4154

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M2243 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376654988 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1215094933 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1043277221 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1740308923 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1558612325 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1194771006 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com