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NPI Code Detail

MEDICARE: PARK CITIES WEIGHTLOSS CLINIC, LLC

MEDICARE: PARK CITIES WEIGHTLOSS CLINIC, 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
1207Q00000XFamily Medicine PhysicianM2243TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11376654988OTHERTXNPI
21215094933OTHERTXNPI
31043277221OTHERTXNPI
41740308923OTHERTXNPI
51558612325OTHERTXNPI
61194771006OTHERTXNPI

General Provider Information

NPI Number : 1841664208
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK CITIES WEIGHTLOSS CLINIC, LLC
Provider Business Mailing Address
First Line : 2050 SHADY OAKS DR
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-3510
Country : US
Telephone Number : 817-271-4154
Fax Number : 817-697-1595
Provider Business Practice Location Address
First Line : 6170 SHERRY LN
Second Line : SUITE 300
City : DALLAS
State : TX
Zip : 75225-6350
Country : US
Telephone Number : 214-253-0029
Fax Number : 214-466-6806
Authorized Official
Title or Position : PRESIDENT
Name : MR. STEPHEN JOEL OREN
Credential :
Telephone Number : 817-271-4154
Provider Enumeration Date : 11/23/2015
Last Update Date : 11/23/2015

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Directions to “PARK CITIES WEIGHTLOSS CLINIC, LLC ” Practice Location

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