Healthcare Provider Details

I. General information

NPI: 1770065369
Provider Name (Legal Business Name): SLIM FIT WEIGHT LOSS MECICAL CLINIC AND SPA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2567 BELL RD
MONTGOMERY AL
36117-4369
US

IV. Provider business mailing address

2567 BELL RD
MONTGOMERY AL
36117-4369
US

V. Phone/Fax

Practice location:
  • Phone: 334-450-7758
  • Fax:
Mailing address:
  • Phone: 334-450-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ZSA ZSA COUCH
Title or Position: PRESIDENT
Credential: MANAGER
Phone: 334-450-7758