MEDICARE: NEW YOU SURGICAL WEIGHT LOSS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1700588571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YOU SURGICAL WEIGHT LOSS, LLC

Provider Business Mailing Address
First Line	:	1000 DES PERES RD STE 120
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2062
Country	:	US
Telephone Number	:	314-341-2327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 DES PERES RD STE 120
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2062
Country	:	US
Telephone Number	:	314-887-7605
Fax Number	:	314-887-7609

Authorized Official
Title or Position	:	MD/OWNER
Name	:	MATTHEW LANGE
Credential	:
Telephone Number	:	314-887-7605

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/16/2026

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