Healthcare Provider Details

I. General information

NPI: 1700608478
Provider Name (Legal Business Name): WEEKEND HEALTH OF TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

V. Phone/Fax

Practice location:
  • Phone: 212-589-2700
  • Fax: 650-360-0447
Mailing address:
  • Phone: 212-589-2700
  • Fax: 650-360-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANTLEY T JOLLY
Title or Position: PRESIDENT
Credential: MD
Phone: 219-589-2700